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3a > Geris > Flashcards

Geris Flashcards

1
Q

Define Delirium

A

State of confusion that develops quickly and fluctuates in intensity

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2
Q

What are the features of delirium?

A

Acute onset
Fluctuating course
Inattention
Altered level of consciousness
Usually reversible
Associated w/ underlying medical cause

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3
Q

What are the risk factors for delirium?

A

Dementia (x5)
Multiple comorbidities
Physical frailty
Older age
Sensory impairment

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4
Q

What are some precipitating factors of delirium?

A

Drug initiation
Medical illness
Systemic infection
Metabolic derangement
Surgery
Pain
Stroke
Seizures
Systemic organ failure

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5
Q

What are the different types of delirium?

A

Hyperactive
Mixed
Hypoactive

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6
Q

What assessments can be used for delirium?

A

4-AT
CAM
AMT

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7
Q

What are the 1st line Ix?

A

BLOODS - WBC + CRP (infection) / U&Es / LFTs / Glucose / TFTs
CXR
Urinalysis
ECG

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8
Q

What are the 2nd line Ix?

A

BLOODS - serum calcium, B12 and folate
ABG
Blood / sputum culture
CT / MRI head
EEG
Toxicology screen
Bladder scan - retention
LP

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9
Q

What are some causes of delirium?

A

Infection
Drug use - w/drawal / new meds
reduced sensory input - blind / deaf / changing environment
Intercranial problems - stroke / seizures / hemorrhage
Electrolyte imbalances
Constipation
Urinary retention
Heart problems - MI / arrhythmias

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10
Q

How is delirium managed?

A

Treat underlying cause
- Dug review doe poly-pharmacy
- Analgesia
- Laxatives
- Abx for infection
- Correct electrolytes

Manage the environment
- Involve family
- Soft lighting
- Clocks and calendars
- Sleep hygiene
- Correct sensory impairment eg glasses / hearing aids
- Keep mobile and active
- Avoid multiple rooms + different staff
- Minimise provocation eg noise)

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11
Q

What should you monitor in delirium?

A

Vital signs
Bowels
Nutrition
Hydration
Pressure areas
Electrolytes
Response to abx

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12
Q

When do you use drugs in delirium?

What are the indications for drugs?

A

In tx failure

rapid tranquilsation of agitated pts where there is imminent risk of harm
short term control of distress

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13
Q

What drugs do you use?

A

Haloperidol
Lorezapam (given in Parkinson’s / Lewy body dementia due to the EPSEs of haloperidol)

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14
Q

What percentage of delirium patients never recover?

A

20%

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15
Q

What are the consequences of falls?

A

Loss of confidence
Serious injury
Fragility fracture
Complications from long lie

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16
Q

What are some environmental (extrinsic RFs) causes of falls in the elderly?

A

Polypharmacy
Bifocals
Walking aids
Home hazards - Loose rugs / Pets / Furniture etc
Unstable footwear

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17
Q

What are some intrinsic risk factors for falls?

A

Female
Neurological disease
Cognitive decline
Muscle weakness

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18
Q

What are some power / balance cause of falls in elderly people?

A

Inactivity leading to – muscle weakness
Dizziness/loss of balance/loss of proprioception (vertigo)
Pain/MS – osteoarthritis
Previous fall leading to decreased confidence

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19
Q

What are some cardiovascular causes of falls in elderly people?

A

Vasovagal syncope (fainting)
Situational syncope – e.g. micturition (old men, night time)
Postural hypotension
Myocardial infarction
Arrhythmia
Dehydration/shock

20
Q

What are some neurological causes of falls in elderly people?

A

Stroke
PD
Gait disturbance
Visual impairment
Peripheral neuropathy
Vertigo
Myopathy e.g. statin or steroid myopathy

21
Q

What are some medications that increase risk of falls in elderly people?

A

Beznodiazepines - sedative so impair coordination
Diuretics
Anti-hypertensives – ACEi, CCB, Beta blockers
Antidepressants
Antipsychotics
Polypharmacy

22
Q

What are some other causes of falls in elderly people?

A

Infection/sepsis
Delirium / Dementia
Hypoglycaemia
Incontinence
Alcohol – intoxication, neuropathy, Korsakoff’s/Wernicke’s

23
Q

Falls are the leading cause of _____ and are associated with increased ________

A

Falls are the leading cause of fractures and are associated with increased mortality

24
Q

Falls lead to a loss of ________ + __________

A

Falls lead to a loss of confidence + independence

25
Q

Define frailty

A

State of increased vulnerability resulting from ageing associated decline in functional reserve

Across multiple physiological systems

Resulting in compromised ability to cope with everyday or acute stressors

26
Q

What is the impact of frailty on elderly people and how does it change how they need to be cared for?

A

Different type of doctor – geriatricians are experts in frailty

Poor functional reserve – trivial insult to a younger person has a large impact on an older person

Failure to integrate responses in the face of stress
Vulnerable to decompensation when faced with illness, drug side effects and metabolic disturbance

27
Q

Frailty correlates with increasing ___, _____ + _____

A

Frailty correlates with increasing age, disease + disability

28
Q

What is the Frailty Phenotype as defined by the Fried model?

A

The presence of 3 or more of:
- Unintentional wt loss
- Weakness evidenced by poor grip strength
- Self reported exhaustion
- Slow walking speed
- Low level of physical activity

29
Q

What are individuals w/ one or 2 characteristics classed as?

A

Pre-frail

30
Q

What is phenotypic frailty predictive of?

A

A higher risk of falls, hospitalisation, disability + death

31
Q

What is the frailty index?

A

A count of health deficits

IE - the more deficits the frailer the person and the greater the risk of deterioration and death

32
Q

What is the best known frailty index?

A

Rockwood Frailty Index

33
Q

What counts as a deficit in the frailty index?

How are they weighed?

A

Symptoms / Signs / Diseases / Disabilities / Ix findings

Each one is weighed the same

34
Q

How is the Ratio calculated? (frailty index)

A

Number or deficits / Total number of deficits considered

35
Q

What is the limitation of the frailty index?

A

Detailed measurements and collation of pt data is needed.

36
Q

What are physiological markers of frailty?

A

Increased inflammation - EG CRP / IL6 / Factor VIII + Fibrinogen
Elevated insulin and glucose levels in fasting state
Low albumin
Raised D dimer and alpha anti-trypsin
Low Vit D levels

37
Q

What are the different categories on the Frailty index?

A

Very fit
Well
Managing well
Vulnerable
Mildly frail
Moderately frail
Severely frail
Very seriously frail
Terminally ill

38
Q

What does Very Fit mean on the Frailty index?

A

Very fit = <0.09 – robust, active, energetic, motivated

39
Q

What does Well mean on the Frailty index?

A

Well – no active disease and exercise occasionally

40
Q

What does Managing Well mean on the frailty index?

A

Managing well – medical problems are well controlled but not regularly active beyond walking

41
Q

What does Vulnerable mean on the frailty index?

A

Vulnerable – symptoms limit activities, tired during day

42
Q

What does Mildly Frail mean on the frailty index?

A

Mildly frail = 0.27 – need help for high order ADLs e.g. finance

43
Q

What does Moderately Frail mean on the frailty index?

A

Moderately frail – need help with house keeping and bathing

44
Q

What does Severely Frail mean on the frailty index?

A

Severely frail = 0.42 – completely dependent for personal care, not at high risk of dying

45
Q

What does Very Seriously Frail mean on the frailty index?

A

Very seriously frail – completely dependent, approaching end of life

46
Q

What does Terminally Ill mean on the frailty index?

A

Terminally ill – life expectancy <6 months but may not be evidently frail

47
Q

What are some interventions for frailty?

A

Physical activity (Exercises focusing on strength and balance)

Protein-calorie supplementation

Vit D supplements

Minimisation of polypharmacy to reduce risk of frailty

3a (1 decks)

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