Gerontology Flashcards
Treatment with which drug class has been assoc. w. a reduced incidence of dementia?
Anti-hypertensives (spec. Indapamide/ enalapril)
Which anti-psychotic is the best choice/ least harmful choice in demented elderly with severe behavioural problems?
Risperidone short term to 12 weeks (2006 systems review; it improves agitation and aggression therefore PBS listed for BPSD. haloperidol has effects on aggression but not agitation; olanzapine does not improve either)
What helps with prophylaxis of delirium?
PRN oxycodone for pain (NOT haloperidol, NOT melatonin- doesn’t help w. post-op delerium; NOT dexmedetomidine). Least worst opiate to use for pain relief re. delirium is Oxycodone
What changes to dopamine/acetylcholine do you get in delirium
Increased dopamine and decreased ACh
Oral antibiotic prophylaxis prescribed for prevention of recurrent UTI in older adult MEN is assoc. w. :
Decreased risk of future UTI assoc. hospitalisation in men
What is not an early indicator of frailty and what are 3 early indicators of frailty?
NOT: weight loss; ARE: slowed walking speed, weakness, reduced physical activity
Barthel Index assesses
ADLs
Vaccine in oldies that best reduces mortality
Influenza
Order of meds to cease in Parkinson’s if psychotic symptoms
Anticholinergics (selegiline, amantadine)
Dopamine agonists
Levodopa
NH resident risk of falling per year
50%
Community >65yo risk of falling per year
30%
Community >80yo risk of falling/year
50%
Top 5 med classes contributing to falls
Anti-depressants Anti-psych Benzos Sedatives Anti-HTN
What timed up and go = higher falls risk
> 13s
BEST intervention to prevent falls in community
Exercise
Vit D supplement only if deplete
Vision interventions to reduce falls
Cataract
Single lens glasses reduce outdoor falls
Falls interventions in NH residents
?Vit D supplementation
Otherwise nothing
Define frailty phenotype
3/5 of: weight loss >5%, ezhaustion, weakness, slow walking speed, reduced physical activity
1 RF for dementia
Age
3 variants of FTD
Progressive non-fluent aphasia
Semantic dementia
Behavioural variant
Pathological hallmarks of AD
Extracellular amyloid plaques, intracellular NFTs of tau
Pathological hallmark of FTD
Tau accumulation
Pathological hallmark of DLB
Alpha-synuclein
3 alpha-synucleinopathies
MSA, PD, LBD
Tauopathies
FTD, PSP, FTD, CTE (chronic traumatic encephalop), PART (primary age related tauopathy)
AD is secondary tau
MOA memantine
Low affinity NMDA antag, inhibit excitatory neurotoxicity
MMSE 10-14
Dementia that best responds to donepezil
LBD
Donepezil AEs
Bradycardia, longQT, lowers seizure threshold, GI AEs, urinary frequency
Major genetic risk for AD
ApoE4
Define polypharm
5+ meds
Most common delirium type
Mixed
Delirium type with worst prognosis
Hypoactive
% falls in hosp assoc w/ delirium
75-90%
1 RF for delirium
Cog impairment
Restraints and malnutirion increase risk of delirium by…
4x
Top 6 RFs delirium in >70yos
Cog impair Reduced sleep Immobility Visual impairment Hearing impairment Dehydration
Relationship between opioids and delirium post-op
Lower dose = more pain = more delirium
Sarcopaenia due to relative loss of:
Type 2 muscle fibres (fast twitch)
