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Gerrys Flashcards

1
Q

what is frailty?

A

health state related to aging in which multiple body systems gradually lose their built in reserves

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2
Q

what is the phenotype model of frailty? (5)

A

unintentional weight loss
weakness
exhaustion
low levels of activity
slow gait

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3
Q

what is the cumultive deficit model of frailty?

A

a count of health deficits which accumulate increasing the risk of deterioration and death. Can be calculated in a frailty index

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4
Q

what are 5 possible physiological markers of frailty?

A

raised inflammatory markers
raised insulin and glucose
low albumin
raised D dimers and alpha antitrypsin
low vit d

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5
Q

what are 4 interventions for frailty?

A

physical activity
protein-calorie suplementation
Vitamin D supplementation
Polypharmacy prevention

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6
Q

what are the 5 domains of the comprehensive geriatric assessment?

A

physical health
mental health
functional ability
social circumstance
environment

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7
Q

what is meant by 2 stage mental capacity test?

A

stage 1 - is there an impairment or disturbance in mental functioning?

stage 2 - does the person lack capacity?

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8
Q

what are the 4 components of capacity?

A

understand information
retain information
weigh up
communicate decision

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9
Q

what are the 4 pillars of medical ethics?

A

non-maleficence
autonomy
justice
beneficence

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10
Q

what are 3 different types of justice?

A

legistlative (legal)
rights based
distributive

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11
Q

what are 7 different types of elder abuse?

A

physical
financial
psychological
neglect
sexual
discrimination
institutional

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12
Q

what is elder abuse?

A

a single or repeated act or lack of appropriate action occuring in any relationship where there is an expectation of trust which causes harm or distress to an older person

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13
Q

what are 5 causes of secondary osteoporosis?

A

rheumatoid arthritis
hyperthyroid/parathyroid
premature menopause <45
chronic malabsoption/malnutrition
chronic liver disease

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14
Q

what are 7 intrinsic risk factors for falls?

A

female
neurological disease
cognitive decline
visual deficit
muscle weakness
impaired proprioception
impaired vestibular system

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15
Q

what are 5 extrinsic risk factors for falls?

A

polypharmacy
bifocals
walking aids
poor footwear
home hazards

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16
Q

what are 4 complications of long lies?

A

rhabdomyolysis
hypothermia
pneumonia
pressure sores

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17
Q

what is classed as polypharmacy?

A

> 4 drugs

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18
Q

what investigations should be done after a fall?

A

ECG - arrythmias/cardiac causes
Lying and standing BP

FBC - anaemia, infection
U+E - dehydration, rhabdo, drug clearance
CK - long lie
Bone biochem - serum Ca2+, phosphate vit D, PTH
Tilt table test
ECHO

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19
Q

what is postural hypotension?

A

drop >20mmHz systolic or >10mmHz diastolic

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20
Q

what are 7 medications associated with postural hypotension?

A

nitrates
diuretics
anticholinergics
antidepressants
beta-blockers
l-dopa
ACEi

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21
Q

what medication can help venous return in orthostatic hypotension?

A

fludrocortisone

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22
Q

what is the link between alcohol and urinary incontinence?

A

causes polyuria, frequency and delerium

23
Q

what is the link between ACEI and incontinence?

A

causes cough => stress incontinence

24
Q

what is the link between anticholinergics and urinary incontinence?

A

urinary retention and overflow incontinence

25
what is the link between diuretics and urinary incontinence?
frequency, polyuria, urgency
26
what is the link between opiates and urinary incontinence?
delerium, sedation, constipation, urinary retention
27
what is the link between tricyclic antidepressants and urinary incontinence?
urinary retention and overflow incontinence
28
what are 5 side effects of duloxetine?
difficulty sleeping headache, dizziness, blurred vision GI upset - constipation/diarrheoa/sickness dry mouth sexual problems
29
what are the 5 components of the complete geriatric assessment?
Physical health mental health function social circumstances Environment
30
what are 2 risk assessments for nutrition in the elderly?
Malnutrition universal screening tool (MUST) Mini nutritional assessment
31
how to calculate a MUST score?
BMI - 18.5-20 (1), <18.5(2) Wt loss score - 5-10% (1), >10% (2) +2 => if acutely unwell
32
what is the management for a medium risk MUST score?
document dietary intake for 3 days
33
what is the management for a high risk MUST score?
refer to dietition, nutritional support team set goals to improve and increase overall nutrition Monitor
34
what are 13 causes of malnutrition in the elderly? Mneumonic
MEALS ON WHEELS Medication Emotion (depression) Annorexia/Alcohol Late life paranoia Swallowing problems Oral and dental disorders No money Wandering (dementia) Hyperthyroid Enteric problems Eating problems Low salt/cholesterol diet Social problems
35
what are 8 symptoms of refeeding syndrome?
arrythmia, HTN, CHF abdo pain, constipation, vomiting Musc weakness, myalgia, rhabdo SOB, resp muscle weakness
36
what is the pathophysiology of refeeding syndrome?
chronic malnutrition leads to protein catabolism total body phosphate depletion despite normal serum phosphate intro of carbs leads to anabolic state which unmasks phosphate deplesion leading to drop in serum phosphate leading to arrythmia
37
what is the management for malnutrition?
refeeding social support
38
What is inappropriate prescribing?
prescribing contraindicated drugs prescribing inappropriate dose/duration Prescribing drug with likely adverse affect failure to use drug that could improve outcome
39
what are the risks of polypharmacy?
increased risk of side effects increased risk of drug-drug interactions therapuetic cascade increased risk of failure to review medications properly
40
what are 6 non-blood investigations for falls?
ECG Lying and standing BP ECHO tilt table test 24 hour tape Imaging (for injury)
41
what are 5 bloods for falls?
FBC - anaemia, infection U+E - dehydration, rhabdo, drug clearance CK - rhabdo Bone biochem - serum calcium, phosphate, vit D, PTH TFTs - thyroid disease
42
what is carotid sinus hypersensitivity?
in elderly people when the carotid sinus is stimulated at its bifurcation this can cause bradycardia and a reduction in BP leading to ventricular pause and fall in BP >50mmHg associated with syncope
43
what is sick sinus syndrome?
arrythmia due to disfunction of sinus node often caused by ischemic changes which causes bradycardia, arrythmia and dropped beats leading to syncope, fatigue and SOB
44
what are the 3 different types of delirium?
hyperactive hypoactive mixed
45
what are 6 risk factors for delirium?
dementia comorbidities physical frailty older age sensory impairment (blind/deaf) polypharmacy
46
what are 7 causes of delirium? mneumonic
PINCH ME Pain Infection Nutrition Constipation Hydration Medication Environment Also - alcohol withdrawal, metabolic disturbance
47
what are 4 key features of delirium?
disturbance of consciousness (inattention) changes in cognition or perceptual disturbance develops over short period of time and fluctuates hx suggests underlying medical cause
48
what medication can be used if a delirious patient is aggitated?
1 - haloperidol 0.5mg
49
what medication should be used in an aggitated patient with parkinsons or lewy body dementia?
lorazepam
50
what screening test can be used to screen for delirium?
4AT
51
what is the 4AT test?
for delirium Alertness Age, DOB, Place, Year Attention - months backwards Acute change or fluctuating course
52
what is multimorbidity?
presence of two or more long term health conditions
53
what questionnaire can be used to assess frailty?
PRISMA-7
54
what tool can be used to identify medications that should/should not be used in the elderly?
STOPP/START tool

Phase 4 (22 decks)

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