Geriatrics Flashcards
What is the difference between primary and secondary aging?
Primary is the biological effect of ageing
Secondary is modifiable aspects of ageing
What are the theories of aging?
Stochastic- cumulative damage to body over time
Predetermined- genetics have already decided when a large group of cells will die
Most likely a combination of the two resulting in dysregulated homeostasis
What is the definition of frailty?
A susceptibility state that leads to a person being more likely to lose function in the face of a given environmental challenge
Name four frailty syndromes?
Falls
Delirium
Incontinence
Immobility
What is the effect of ageing on inter individuality?
Increases it
What are the five aspects of the Fried frailty criteria?
Unintentional weight loss Exhaustion Weak grip strength Slow walking speed Low physical activity 3 or more means frail
What is decompensated frailty?
When an adverse effect knocks off a patient’s homeostasis and this progressively leads them further down the frailty spectrum.
What is a comprehensive geriatric assessment?
Process to assess and manage illness in older people with frailty
What are four kinds of incontinence and what causes them?
Stress incontinence caused by weak bladder outlet/pelvic floor muscles
Urinary retention with overflow is caused by obstruction (prostate, cryptogenic fibrosis of urethra, after colposuspension surgery and radiotherapy effects)
Urge incontinence caused by an overly strong bladder muscle
Neuropathic bladder is an underactive bladder that doesn’t contract (can be from long term catheterisation)
What drugs can cause falls?
Antihypertensive Beta blocker Sedatives Anticholingerics Opioids Alcohol
What are the features of delirium?
Disturbed consciousness Hypoactive/hyperactive/mixed Change in cognition Memory/perceptual/language/illusions/hallucinations Acute onset and fluctuant Disturbance of sleep wake cycle Disturbed psychomotor behaviour Emotional disturbance
What things can precipitate delirium?
Infection (but not always a UTI!) Dehydration Biochemical disturbance Pain Drugs Constipation/Urinary retention Hypoxia Alcohol/drug withdrawal Sleep disturbance Brain injury Stroke/tumour/bleed etc Changes in environment/emotional distress Idiopathic Multiple triggers
What is a tool that can be used to screen for delirium?
4AT that should be used in all patients over 65
Alertness (awake, woken up, not)
Cognition (LADY)
Attention (say months back)
Acute change (ask relatives, care givers, patients)
What is the non pharmacological treatment for delirium?
Re-orientate and reassure agitated patients Encourage early mobility and self-care Correction of sensory impairment Normalise sleep-wake cycle Ensure continuity of care Avoid hospitalisation if possible Avoid frequent ward or room transfers Avoid urinary catheterisation/venflons Discharge people
