Gerontology Flashcards
What are the frailty syndromes?
- Falls (collapse, legs given way)
- Delirium (acute confusional state, or acute confusion in those with existing cognitive impariment)
- Immobility (sudden change in mobility e.g. gone “off legs”)
- Incontinence (either new onset or sudden worsening)
- Susceptibility to SE of medications (e.g. confusion w/ codeine, hypotension w/ antidepressents)
What is the definition of frailty?
The reduction in functional reserve that accompanies ageing in different body systems that means minor bodily insults e.g. a new medication, minor illness have massive consequences for the individual including complete loss of independence.
Frailty is vulnerability to loss of function but not established loss of function (disability).
What do the two models of frailty use to describe the concept of frailty?
- Phenotypic: a group of patient characteristics that if present predict poor outcomes. These include: unintended weight loss, loss of muscle strength, reduced gait speed, self reported exhaustion, low E expenditure.
- Cumulative deficit: several deficits acquired over time via ageing process that combine to increase risk of ADRs. These deficits include: loss of hearing/vision, low mood, tremor, CI.
What are the components of the International Classification of Function?
Components: Impairment, Body function + structure, Activity, Participation, (Contextual) Personal Factors and Environmental Factors.
Body function + structure- physiological functions of body + anatomy of body
Impairment- problems in body function as a significant deviation or loss
Activity- Execution of task/ action by individual
Participation- involvement in life situation
Personal factors- factors that affect how disability affects individual e.g. gender, age, coping styles, social background, education, profession, past and current experience, character
Env factors- social attitudes, architectural characteristics, legal and social structures, terrain. Can be barriers / facilitators (e.g. wheelchair is facilitating)
Advantages over purely medical model of disability i.e. the need to “fix” the problem or the social model of disability that the problem is created by society’s hostile environment and attitudes and not an attribute of the person at all. These are both inadequate bc they do not describe the interaction between the physical health of an individual and their environment.
Define Comprehensive Geriatric Assessment and list its domains.
The Gold standard framework for the management of frailty in older adults which is a multidimensional and usually interdisciplinary diagnostic process designed to determine a frail older person’s medical conditions, mental health, functional capacity and social circumstances. The purpose is to plan and carry out a holistic plan for treatment, rehabilitation, support and long term follow up.
It is patient centered, covers co-morbidities and end of life care.
Domains: Medical + Physical, Social, Functioning, Mental Health, Environment
What is the process of the CGA?
- Screening for Frailty (when patient comes into contact with therapy/ medical services- should NOT be routine screening for all older adults). Patients ID as frail through a variety of means including Timed Up and Go, PRISMA-7, gait speed etc.
- Establishing a problem list:
medical: med review, co-morbid conditions, disease severity, nutritional status.
MH: cognition, mood, fears
Functional: ADLs, Gait and Balance, activity/ exercise status
Social: informal network of fam/friends, daytime activities, eligibility for care resources.
Environment: home comfort, safety, transport, accessibility to local resources, use/ pot use of telehealth - Create management plan including goals, EoLcare plan, Escalation plan and a review date to make changes to the plan.
MDT is involved in communicating findings and reaching a management plan that is acceptable for the patient.
What are some of the physiological consequences of ageing?
Ageing is the progressive accumulation of multiple random molecular defects that despite repair mechanisms eventually lead to the functional impairment of tissues and organs.
Bones: decreased bone mineral density increasing risk osteoporosis
CNS: neuronal loss increases chance of delirium
anterior horn cell loss- increased muscle wasting and weakness
dorsal column cell loss- reduced position and vibration sense
slowed reaction time- increased chance of falls
Resp: reduced lung elasticity + aveolar support- reduced vital capacity + peak expiratory flow
increased chest wall rigidity- increased residual volume
+ reduced inspiratory volume
reduced cough + ciliary action- increased infection
CVD: reduced max HR= reduced exercise tolerance
reduced elasticity of vessels- widened PP, postural hypotension
reduced no pacing myocytes in SA node- increased chance AF
GI: reduced motility- constipation
Renal: loss of nephrons- impaired fluid balance
reduced GFR- increased chance dehydration/ overload
reduced tubular function- decreased metabolism/ excretion of meds
In Palliative Care, what does the term “double effect” describe?
It is acceptable that treatment is life-shortening where medication is a proportionate response to symptom relief
What are the uses of hyosine hydrobromide?
Reduces secretions.
Sedative and anti-spasmodic and also anti-emetic.
