Geriatrics I Flashcards
What is frailty?
Frailty is a distinctive health state related to the ageing process in which multiple body systems gradually lose their in-built reserves. Around 10 per cent of people aged over 65 years have frailty, rising to between a quarter and a half of those aged over 85.
- dyshomeostasis, alongside soco-environmental insults
syndrome of:
Falls
Delirium
Immobility
Incontinence
Presentations of diseases in frailty
- in frailty may have diff presentations vs classic pres.
HYPERTHYR.
Depression
Cognitive impairment
Muscle weakness
Atrial fibrillation
Heart failure
Angina
Implications in Geriatrics
- increasing co-morb.
- increasing inter-variability in organ reserve and funct.
- variable pres.
- little drug evidence for 80yo+
- POLYPHARM.
Be aware of the importance of a multi-dimensional and multi-disciplinary holistic approach to assess and address multi-component health problems in elderly.
a
Frailty Phenotype
3 out of 5
Unintentional weight loss
Exhaustion
Weak grip strength
Slow walking speed
Low physical activity
System Failure in Frailty
Compromise of functional systems that allow daily activity and functionality
* mobility = getting up
* comprehension = reacting and acting to every day
* self-care skills = independence
= frailty syndrome
> Hx taking = ADL = activities of daily living to assess function and needs
Comprehensve Geri Assess.
goal centred, holistic, multidisciplin.
mdt:
dr = broad overview and responsibility, medical contributors
physio = assess mobility
OT = ADLs
Nurses = care needs and assessments long-term
+ others
Explain the typical symptom pattern associated with each of the main types of incontinence andmgmt
1) STRESS INCONTINENCE
weak bladder outlet
- urine leak w/ pressure, movement
- women w/ children, post-menopausal
> physio
oestrogen cream + duloxetine
sx option
2) RETENTION + OVERFLOW. INCONTINENCE
strong bladder outlet
- poor flow, voiding, hesitancy, dribbling
- urethra blocking, BPH
> a-blocker - TAMSULOSIN relaxes sphincter
anti-androgen - FINASTERIDE shrinks prostate
suprapubic cath.
3) URGE
strong bladder muscle
- detrusor contracts low volumes = SUDDEN NEED
- bladder stones? or stroke
> anti-muscarinics - OXYBUTININ, TOLTERODINE, SOLIFENACIN relaxes detrusor
beta3 adrenoreceptor agonists - MIRABEGRON relaxes detrusor
bladder re-training
4) NEUROPATHIC BLADDER
underactive
- rare, 2º neuro. e.g MS, stroke, or prolonged cath.
- no awareness thus leads to overflow
> cath
or sometimes parasympathomimetics
Factors contributing to Incontiencne
extr. factors
- physical. state
- mobility
- confusion
- inappt. drinking pattern
- MEDICATIONS
- constipation
- circumstances
intr. factors
- bladder
- outlet
- too weak, too strong
when to refer urinary incontinence
Failure of initial mgmt
max 3mos of mgmt
OR
- fistula
- palpable bladder after micturition = RETENTION
- CNS disease
- organic pelvic disease
Local Innervation and Urinary Function
S2-S4 (para) = CONTRACTION strenght & freq
T10-L2 (symp.) = DETRUSOR RELAX b-adrenoreceptor
T10-S2 (symp.) = BLADDER NECK and INT. SPHINCTER CONTRACTION a-adrenorecept.
S2-S4 (somatic) = UROGENITAL DIAPHGRAGM CONTRACTION & EXT. SPHINCTEER
+CNS inhibit parasym tone promoting relaxation thus storage
+ sphincter closure mediated by a-adrenergic and somatic activity
+ pontine micturition centre storage progam
+ frontal cortex, caudal spinal cord part
Referring faecal incontinence
Faecal incontinence
Referral after failure of initial management:
Constipation or diarrhoea with normal sphincter
Referral necessary at onset:
Suspected sphincter damage
Neurological disease
- Describe the main clinical features of delirium, its investigation and management
- disturbed consciousness: hypo, hyper, mixed
- change in cognition
- acute onsent and fluctuant
+ disturbed sleep/wake cycle
+ disturbed psychomotor behaviour
+ emotional disturbance
may be precipitated by infection, dehydration, pain etc. = INSULT
*post sx
* EoLife
- 4AT;
4+ possible delirium ±cog impairment
1-3 pos. cog impairment
0 - unlikely
> treat cause
TIME bundle
orientation of pt. and independence
> !QUETIAPINE (oral) only if danger to themselves or others
- Appreciate how to differentiate delirium from other types of cognitive impairment
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Appreciate the impact delirium has on people, their relatives, and the staff looking after them
- SIGNIFICANT FALLS RISK
