Geriatrics Teaching Flashcards
What is frailty?
A state of increased vulnerability resulting from ageing associated decline in reserve and function across multiple systems, such that the ability to cope with stressors is reduced
What are the most common presentations to geriatric medicine?
Falls, confusion, incontinence, immobility, chest pain, SOB, urinary symptoms
What are some of the added complications that come with treating older patients?
Non-specific presentations, complex co-morbidities, reduced organ function, more prone to side-effects, polypharmacy
What is deconditioning?
Deterioration of function that happens due to an illness usually
What is the comprehensive geriatric assessment (CGA)?
A process focused on determining a frail older person’s medical, psychological, social and functional capacity
What is included in the CGA medical assessment?
Problem list, co-morbidities, medication review, nutritional status
What is included in the CGA functional assessment?
Activities of daily living, activity/exercise status, gait and balance
What factors increase the risk of dying from Covid-19?
Ethnicity, BMI, Co-morbidities, immunosuppression, age
What is the management for an elderly patient with Covid-19 infection?
Frailty assessment, DNAR form, antibiotics, fluids, oxygen, resp rate, escalation plan, physio
What is the management for palliative covid infection?
Oxygen, reduce unneccessary meds, pre-emptive prescribing of opiates, sedatives, hyoscine for secretions)
What is the most common cause of major trauma?
Elderly patient’s falling indoors
What is a fragility fracture?
A fracture from standing height or less
What are the six components of the best practice tariff for hip fractures?
Prompt surgery within 36 hours, prompt orthogeriatric assessment within 72 hours, pre-operative cognitive testing, delirium assessment post-operatively, prompt mobilisation after surgery, fracture prevention assessments, nutritional assessment
What lifestyle factors can prevent frailty?
Good nutrition, physical activity, avoid social isolation, reduce alcohol
How is frailty assessed?
Clinical frailty scale, walking speed, grip strength
How can you reduce post-operative delerium?
Oxygen, correcting anaemia, maintaining fluids and electrolytes, analgesia, ensuring regular bowel and bladder function, nutritional support, appropriate environmental stimuli
What analgesia are typically used in hip fractures?
Fascia iliaca nerve block, paracetamol, opioids (+laxative) - usually buprenorphine patch.
What tool can be used to assess risk of fractures?
FRAX score
What measures can be used to reduce risk of fractures?
Weight-bearing exercises, muscle strengthening, falls prevention, smoking cessation, avoid alcohol, calcium and Vit D supplements, Bisphosphonates (alendronic or zolendronic acid)
What is delerium?
An acute confusional state that fluctuates in severity and is usually reversible. Usually the result of another organic process.
What is BPSD?
Behavioural and psychological symptoms of dementia - agitation, irritability, depression, disinhibition, hallucinations
What tests are included in the confusion bloods screen?
Calcium levels, B12, folate, ferritin, TSH
What is the first line treatment of delirium?
Orientation, reassurance, continuity of care, provide hearing aids/glasses/quiet environment
Sedation (haloperidol, lorazepam) if risk to self/others
Can you have delirium and dementia?
Yes, they can occur simultaneously
How do you diagnose dementia?
Long-term history - decline in memory with impairment of at least one other cognitive function, such as skilled movements, language or executive function for > 6 months
What are the common causes of reversible dementia?
Depression, B12/folate, hypothyroid, NPH
What is the difference between hypo and hyperactive delirium?
Hypo - lethargy, slowness, sleepy, inattention
Hyper - aggressive, confused, agitated, hallucination
What is a TIA?
Transient Ischaemic Attack - less than 24 hours neurological dysfunction caused by focal brain, spinal cord or retinal ischaemia without evidence of acute infarction
What is the acute management of a TIA?
High dose (300mg) aspirin to prevent stroke, refer to specialist
What is the ABCD2 score?
A score used to put someone into the category of a low or high risk TIA (age, BP, clinical features of TIA, how long it lasts, diabetes)
What investigations are done for TIA and stroke?
Bloods, ECG, USS carotid, brain imagining, ?echo, 24hr tape
What is the management for a TIA?
Antiplatelet therapy - aspirin/clopidogrel
What are the three main causes of ischaemic stroke?
Atherosclerosis, cardio-embolic, dissection
What are some common causes of carotid dissection?
Over-extending the neck - cycling, painting ceiling, hairdressers leaning back
How fast should neuroimaging be done after stroke admission?
Within 1 hour
What is the short term management of an ischaemic stroke?
Anti-platelets (aspirin 300mg OD for 2 weeks, then swap for clopidogrel), manage BP, thrombolysis, thrombectomy, endarterectomy
What is the long-term management of ischaemic stroke?
Lifestyle - salt, exercise, smoking alcohol, lipids - reduce by 40%, keep BP under 130/80
What is a carotid endarterectomy?
Removal of the plaque from the carotid artery
Give an example of a drug used for thrombolysis?
Alteplase
When can alteplase be used for thrombolysis?
If patients present within 4.5 hours of stroke
What are the causes of haemorrhagic stroke?
CAA - amyloid beta peptide deposits in arteries, hypertension, aneurysms, AVMs, trauma, blood thinners
What is the treatment for haemorrhagic stroke?
BP management < 140/80, reverse anticoagulation, neurosurgical referral, drain if hydrocephalus
What is blood pressure like after a TIA?
Higher - due to body trying to re-perfuse the area
How long do you not drive after a TIA?
one month
What are the main general causes of malnutrition?
Impaired nutrient intake, increased nutrient requirements, malabsorption or inability to use ingested nutrients
What are the consequences of malnutrition?
Decreased immunity, muscle wasting, impaired wound healing, poorer recovery outcomes
What is the MUST score?
The malnutrition Universal Screening Tool - scores a patient based on their BMI, history of weight loss, acute disease effect
How often are MUST scores completed?
Weekly/ every outpatient appointment
What is the approach to treating malnutrition?
Food first, supplements, then enteral/parenteral nutrition
What types of nutritional supplements are offered?
milkshake style (fortisip), juice style, high energy powders, soup style, semi-solid, high protein
What is enteral nutrition?
Direct feeding into the gut - usually stomach or duodenum and jejunum
What are the benefits of enteral nutrition?
Preserves gut mucosa and integrity, improves nutritional status, inexpensive compared to parenteral nutrition
What are the typical routes of short term enteral nutrition?
Nasogastric tube (can be inserted at ward level, can be checked by pH), nasojejunal tube (needs radiological assistance, cant be checked using aspirate.
What are the typical routes for long term enteral nutrition?
PEG (Percutaneous endoscopic gastrostomy), PEJ - jejunoscomy
What are the indications for parenteral nutrition?
Inadequate absorption, GI fistula, bowel obstruction, severe malnutrition
What is refeeding syndrome?
A group of clinical symptoms asssociated with the reintroduction of nutrition after starvation/malnourishment. Shift in use of fats to carbs as energy, initiates insulin increase and cellular uptake of potassium, phosphate and magnesium - can cause fluid retention, arrhythmias, resp insufficiency
What is the management of refeeding syndrome?
IV pabrinex(B1 and B12) or thiamine + vitamin B prior to feeding and for first 10 days. Slow reintroduction of nutrition, daily blood monitoring
What is the Fried criteria?
A criteria for frailty - unintentional weight loss, self reported exhaustion, weakness, slow walking sleep, low physical activity
In which individuals can the clinical frailty scale be used?
Individuals over 65 and not with an acute illness
What is the e-FI?
The electronic frailty index, based on retrospective cohort data and calculated on the presence or absence of individual deficits as a proportion of 36 - including social factors, comorbidities and self-reported symptoms
When is end of life?
Within the last 12 months of life
What is advance care planning?
A process of discussion about goals of care and means of setting on record preferences for care of patients who may lose capacity or communicating ability in the future
What is sarcopenia?
Loss of muscle mass or function - usually measured by loss of grip strength and slow walking
How are hospitals not good for you?
No exercise - deconditioning, poor nutrition, unusual environment
How do we prevent frailty and sarcopenia?
Being treated for their conditions - balance, nutrition, exercise, home assessment, social needs, therapy assessments
