geris Flashcards
blackouts
many possible causes
vasovagal- reflex bradycardia +/- peripheral vasodilation— emotion, pain, standing for long time.
S+S; nausea, pallor, swaeating, narrowing of visual fields.
presyncopial symptoms- breif clonic jerking may be present. incontinence uncommon. rapid recovery.
situational syncope- same S+S as vasovagal syncope–> but related to something e.g exertion, coughing, micturition.
stokes-adams attacks–> transient arrythmia (e.g brady due to heart block) –> sudden fall to ground, no warning (maybe palpitation) –> pale + slow pulse which then flushes and speeds up.
Ix: full cardio/ neuro exam.
Ix: lying and standing BP, cardio exam, bloods for electrolite disturbances.
avoid driving whilst being investigated.
Rx: cause of symptoms.
Note: tounge biting, incontinence, confusion/ sleepy, muscle ache, complexion change toward cyanosis during, tense before—> all point to epilepsy rather than syncope.
discuss dizzyness
again many causes:
BPPV, acute labrynthitis, meniers disease, ototoxicity, acoustic neuroma, damage etc etc
True vertigo is a hallucination of movement.
loss of awareness - think epilepsy
faintness/ lightheadedness–> think anaemia, anxiety hypotension etc.
no strict definition- but an act or lack of action that causes harm to oler people
RF: over 75, cognitive impairment. dependance, depression, substance abuse, financial dependance
look out for inconsistent history, fear/ agitation, malnutrition, pressure ulcers, unkempt.
typically from someone that a person depends on, but recenetly been more from strangers for financial gain over internet.
Ix: photos of any injuries. thorough history taking.
RX: MDT approach, social services refferal
electrolite imbalaces in the elderly
loose ability to concerntrate fully, or dilute fully urine, resulting in slower normalisation of electrolites.
when stress is placed on the body, hey can loose the ablity to regulate.
most commonly Na
Rf: increace insensible losses, inability to get to water sourse, inability to retain free water (concentration issues) decreace in thirst.
Rx: stopp causitive medications, fluid restriction, rx underlying conditions
faecal incontinence
often a multifactoral disease, local, anatomical and systemic disorders all possible causes, sometimes no cause is found.
affects up to 10% of adults.
RF: female, age, nursing home resident, forceps delivery, obstetric trauma, MS, constipation, prolapse.
Ix: visual inspection- try and identify prolapse, fistulae etc.
endoscopy to assess internally.
Rx: manage reversable causes first, consider refferal to services.
consider fibre- food diary.
consider- pads, plugs.
pelvic floor exs, biofeedback, electrical stim.
if associated with loose stool- antidiarrhoeal agents. (loperamide/ codeine.)
if constipation/ overflow the problem- enemas, supositories. if they dont work only then try lactulose/ senna.
surgical options- sacral nerve stim, anterior sphincter repair is possible.
if everything else exhausted- colostomy/ ileostomy.
discuss falls in the elderly.
each year nearly 700 000 die from falls worldwide.
1 in 4 older adults falls yearly.
causes are often multifactoral
syncope, dizzyness/ vertigo, visual/ hearin impairments, cognitive/ mood impairments all contribute.
Ix: CGA and comprehensive falls risk assessment, analysis of home environment.
Rx: multifactoral interventions, tai chi.
related to ageing process but not an inevitable part of.
body systems reduce their in-built reserves. – leading to more vulnerability to stressor states.
minor changes (cold, medication etc) can have big consequences- admit to hosp, falls etc.
increaces adverse outcomes to many many things.
RF: age, malnutrition, Multimorbidity, sarcopena.
2 ways of diagnosing- phenotype- unintantional wt loss, self-reported exhaustion, low energy expenditure, slow gait, weak grip.
3/5= frail, 1 or 2 is pre frail.
culumative defecit model= accumulations of defecit variables- diseases, symptoms, disabilities, abnormal labs.
rockwood frailty score is the main measure.
what is a CGA
process of care with a number of steps. multidimensional holistic assessment of an older person.
assess all aspects of the older persons health
create a problem list + personalised care plan
review interventions and continue assessing.
immobility in the elderly
bedrest is detrimental
10 years of ageing if in bed for 10 days (over 80)
40 years of aging on cvs system if in bed 30 days,
tidal vol in supine is reduced by a 3rd.
plasma vol depleted by 12 by 4 days bed rest
16 times more liekly to experiance constipation
what is interface and community geriatrics
GCA happens in hospital prior to discharge, they then get followed up in the community by the same person to continue the care.
‘interface’
malnutrition in the elderly
1 in 10 over 65
results in longer recovery times, increased re-admission, morbidity and mortality.
decreased appetite, access to healthy foods.
malnutrition related protein canabolism leads to immune deficiency –> reduced ability to recover from infection etc.
linked to frailty.
pressure ulcers
all adults being admitted to 2’ care or nhs care home should have risk assessment performed.
reposition every 6 hours minimum to prevent.
pressure mattress if at high risk. 4 if high risk.
stage 1:non-blanching erythema
stage 2: break in integriety of skin/ partial thickness skin loss.
stage 3: full thickness skin loss
stage 4: full thickness tissue loss
unstageable: very deep.
Rx:
if deep tissue infection is suspected then sharp debridement is indicated.
if not healing then surgical closure can be done.
otherwise autolytic (dressings that retain moisture) can be performed.
discuss presbyopia
age related deterioration in sight
predominantly in fine detail and low light.
may notice it scoobing before out of the water due to lower light down there.
as a result of lens stiffening, and ciliary muscle strength loss. focal point cant get infront of the retina.
Ix: basic eye exam.
Rx: glasses, surgery- cataract for example, or lasik surgery.
eye drops can constrict the pupil and might help.
how long should stroke patients receive therapy for
3 hours 5x a week!
what is a surgical liaison service
similar to orthogeri
a consultant/ team who mediate between patient and surgeon and can help optimise and manage older patients that require surgery.
