Geriatrics - RF, pathology, symptoms Flashcards
Benign paroxysmal positional vertigo
RF
Pathology
Symptoms
RF - Elderly, females, migraines, head trauma, meniere’s disease, previous BPPV diagnosis
Pathology
- One of the most common causes of vertigo
- Occurs due to displacement of otoconia (calcium carbonate crystals) in the semicircular canals (posterior) - through ageing, trauma, infection - disrupting normal flow of endolymph.
50% of people have relapses 3-5 years later
Sx
- Sudden onset dizziness triggered by changes in head position (lasting 10-20 seconds)
- Possible nausea and lightheadedness
- Occurs repeatedly over days/weeks/months
Falls
Age most common
Causes
- Neurology
- Cardiovascular
- Musculoskeletal
- Environmental
People over 65 have 30% risk of falling, people over 80 have 50% risk of falling at least once a year.
Neurological causes
- Visual and/or hearing impairment
- Peripheral neuropathy (e.g. diabetic foot)
- BPPV
- Dementia/delirium/depression
- Seizure
- Stroke
- Haematoma (subdural)
Cardiovascular
- Syncope
- Orthostatic hypotension
- Low blood pressure
Musculoskeletal
- Joint instability
- Pain in joints
- Muscle weakness (sarcopenia)
- Obesity
Environmental
- Fear of falling
- Polypharmacy
- Specific medication e.g. benzodiazepines, antidepressants
- Diabetes medication + associated hypoglycemia
- Substance misuse including alcohol
- Environmental hazards e.g. loose rugs, poor lighting, uneven flooring, living alone.
Frailty
Definition
Factors affecting frailty
Multi system impairment associated with increased vulnerability to stressors
Factors
- Muscle mass
- Energy levels
- Nutrition
- Disease
- Mobility
(Cognitive impairment, depression)
Frailty cycle – E.g. Disease –> reduced muscle mass –> reduced mobility and walking speed –> decreased activity and energy expenditure –> anorexia of ageing –> undernutrition –> sarcopenia
Incontinence
RF
Pathology - 5 types
RF - Increasing age, previous pregnancy and childbirth, high BMI (obesity)
5 types of incontinence
1) Urge incontinence
- Due to overactive detrusor muscle (sometimes not able to get to bathroom on time)
2) Stress incontinence
- Leaking small amounts at times of increased abd pressure (laughing, coughing) –> Weak pelvic floor and sphincter muscles
3) Mixed incontinence
- both urge and stress
4) Overflow incontinence
- Due to urinary retention caused by e.g. BPH, renal stones, tumours (bladder outlet obstruction)
5) Functional incontinence
- Caused by comorbid physical conditions (e.g. dementia, injury)
- Sedating medication
Sarcopenia
Definition
What 3 things are used to assess it?
A loss of muscle mass or function
1) Walking speed
2) Grip strength
3) Muscle mass
Osteoporosis
RF
Pathology
Symptoms
Define
Osteomalacia
Osteopenia
Osteoporosis - A significant reduction in bone density
Osteopenia - A less severe reduction in bone density
Osteomalacia - A reduction in bone mineralisation
Most likely - 50+ caucasian woman
RF - SHATTERED
Steroids
Hyperthyroidism/parathyroidism
Alcohol+smoking
Thin - low BMI
Testosterone
Early menopause
Renal/liver failure - CKD
Erosive disease
Diabetes (type 1)
Pathology - An oversupply of osteoclasts and an undersupply of osteoblasts
Symptoms
Fractures
- Recent fall can lead to proximal femur fracture
- Colles fracture –> Radius fracture. Fall on outstretched wrist
- Possible vertebral fracture
Cardiac failure
RF
Pathology
Symptoms
The heart is unable to pump enough blood to meet the metabolic needs of the body.
RF - hypertension, diabetes, coronary heart disease, elderly, dyslipidaemia, obese
Pathology
<40% Left ventricle ejection fraction - Reduced ejection fraction (usually systolic dysfunction) – IHD, dilated cardiomyopathy
> 40 % - Preserved ejection fraction (usually diastolic dysfunction) – Pericarditis, cardiac tamponade, restrictive cardiomyopathy
Sx
3 cardinal symptoms
- Dyspnoea/orthopnea/PND
- Ankle swelling (oedema)
- Fatigue
(bibasal crackles, elevated JVP)
Symptoms of
Right sided heart failure
Left sided heart failure
Left sided
- Pulmonary oedema
- Paroxysmal nocturnal dyspnoea
- Orthopnea
(bibasal crackles on auscultation)
Right sided
- Peripheral oedema
- Raised JVP
- Hepatomegaly
(Weight gain due to fluid retention)
Constipation
RF
Symptoms
Red flags
Treatment
RF - Females, elderly, sedentary lifestyle, low fluid and fibre intake, drugs that induce constipation
(Faecal impaction is a result of constant constipation when poop is stuck inside of your rectum) - treated with enema or suppository
Sx
- Less than 3 defecations a week
- Failed or lengthy attempts to defecate
- Excessive straining
- Hard stools
Red flags
Neurological - loss of sensation
Vomiting - Hirschprung’s disease
Failure to thrive - coeliac’s
Severe abdominal pain - bowel obstruction
Treatment
Lifestyle - High fibre diet, good hydration
Laxatives
1st line - Bulk forming laxative - Ispaghula husk
if stools remain hard and difficult to pass
can switch to an osmotic laxative e.g. Macrogol (movicol, laxido)
2nd line - Lactulose
If stools are soft and difficult to pass, use a stimulant laxative e.g. Senna
What medications can cause dizziness/syncope leading to falls?
All of this can cause dizziness or orthostatic hypotension
1) Blood pressure lowering medications
- CCB, BB, Ace inhibitors,
2) Anti depressants
- Fluoxetine, sertraline
3) Anti parkinson drugs
- Levodopa, carbidopa
4) Insulin and other diabetic medication
- Can result in hypoglycemia
What is the STOPP criteria specifically for delirium
What is the START criteria in general?
What is the purpose of both of these criterias?
Screening tool of older person’s prescriptions
A guideline designed to identify potentially inappropriate medications in the elderly.
1) Anticholinergics e.g. antidepressants, antihistamines, oxybutynin
2) Opioids - Morphine
3) Benzodiazepines
4) Hypnotics
5) Antipsychotics - Haloperidol
START - Screening tool to alert doctors to right treatments
Goal of both criteria is to support medication review for elderly patients and aims to reduce the incidence of medicines-related adverse events from potentially inappropriate prescribing and polypharmacy.
Causes of malnutrition
- Decreased nutrient intake (starvation)
- Increased nutrient requirement (sepsis, injury)
- Malabsorption
Consequences of malnutrition
- Weakened immune system (more prone to infection)
- Impaired wound healing
- Muscle wasting (leads to falls and decreased mobility)
What is refeeding syndrome?
Pathology
Treatment
A group of clinical symptoms/signs that a malnourished/starved patient experiences when reintroducing nutrition.
During starvation the body adjusts to using fat and protein as the primary source of energy, conserving glucose.
Insulin secretion is suppressed to preserve glucose in the blood.
When carbohydrates are reintroduced, insulin secretion increases dramatically to manage the influx of glucose. (Cellular uptake of electrolytes are required for glucose metabolism e.g. phosphate, magnesium)
This leads to shifts in fluid and electrolytes resulting in electrolyte deficiencies and eventual cellular dysfunction due to electrolyte depletion. –> eventually leading to organ dysfunction.
Results in respiratory insufficiency, cardiac arrhythmias
Tx
IV pabrinex/thiamine + vitamin B (co-strong) prior to feeding and for the first 10 days.
- Slow introduction of nutrition
Hyperthermia (heat exhausation/heat stroke)
Symptoms
Management
(Heat exhaustion does not need emergency medical help if you can cool down in 30 mins) - Heat stroke needs immediate medical attention
Sx
- Tired, dizzy, headache
- Excessive sweating
- Pale and clammy skin
- Tachypnoea and tachycardia
- Fever
- Very thirsty
Tx
1. Move patient to a cool place
2. Remove unnecessary clothing like a jacket or socks
3. Drink a rehydration drink or a cool drink
4. Cool their skin with ice packs on their neck or under armpits. Can use a fan also.
Call 999 if still unwell after 90 mins
(information from NHS)
