Gerrys Flashcards
what is frailty?
health state related to aging in which multiple body systems gradually lose their built in reserves
what is the phenotype model of frailty? (5)
unintentional weight loss
weakness
exhaustion
low levels of activity
slow gait
what is the cumultive deficit model of frailty?
a count of health deficits which accumulate increasing the risk of deterioration and death. Can be calculated in a frailty index
what are 5 possible physiological markers of frailty?
raised inflammatory markers
raised insulin and glucose
low albumin
raised D dimers and alpha antitrypsin
low vit d
what are 4 interventions for frailty?
physical activity
protein-calorie suplementation
Vitamin D supplementation
Polypharmacy prevention
what are the 5 domains of the comprehensive geriatric assessment?
physical health
mental health
functional ability
social circumstance
environment
what is meant by 2 stage mental capacity test?
stage 1 - is there an impairment or disturbance in mental functioning?
stage 2 - does the person lack capacity?
what are the 4 components of capacity?
understand information
retain information
weigh up
communicate decision
what are the 4 pillars of medical ethics?
non-maleficence
autonomy
justice
beneficence
what are 4 different types of justice?
legistlative (legal)
rights based
distributive
what are 7 different types of elder abuse?
physical
financial
psychological
neglect
sexual
discrimination
institutional
what is elder abuse?
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
what are 5 causes of secondary osteoporosis?
rheumatoid arthritis
hyperthyroid/parathyroid
premature menopause <45
chronic malabsoption/malnutrition
chronic liver disease
what are 7 intrinsic risk factors for falls?
female
neurological disease
cognitive decline
visual deficit
muscle weakness
impaired proprioception
impaired vestibular system
what are 5 extrinsic risk factors for falls?
polypharmacy
bifocals
walking aids
poor footwear
home hazards
what are 4 complications of long lies?
rhabdomyolysis
hypothermia
pneumonia
pressure sores
what is classed as polypharmacy?
> 4 drugs
what investigations should be done after a fall?
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
what is postural hypotension?
drop >20mmHz systolic or >10mmHz diastolic
what are 7 medications associated with postural hypotension?
nitrates
diuretics
anticholinergics
antidepressants
beta-blockers
l-dopa
ACEi
what medication can help venous return in orthostatic hypotension?
fludrocortisone
what is the link between alcohol and urinary incontinence?
causes polyuria, frequency and delerium
what is the link between ACEI and incontinence?
causes cough => stress incontinence
what is the link between anticholinergics and urinary incontinence?
urinary retention and overflow incontinence
what is the link between diuretics and urinary incontinence?
frequency, polyuria, urgency
what is the link between opiates and urinary incontinence?
delerium, sedation, constipation, urinary retention
what is the link between tricyclic antidepressants and urinary incontinence?
urinary retention and overflow incontinence
what are 5 side effects of duloxetine?
difficulty sleeping
headache, dizziness, blurred vision
GI upset - constipation/diarrheoa/sickness
dry mouth
sexual problems
what are the 5 components of the complete geriatric assessment?
Physical health
mental health
function
social circumstances
Environment
what are 2 risk assessments for nutrition in the elderly?
Malnutrition universal screening tool (MUST)
Mini nutritional assessment
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
what is the management for a medium risk MUST score?
document dietary intake for 3 days
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
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
what are 8 symptoms of refeeding syndrome?
arrythmia, HTN, CHF
abdo pain, constipation, vomiting
Musc weakness, myalgia, rhabdo
SOB, resp muscle weakness
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
what is the management for malnutrition?
refeeding
social support
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
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
what are 6 non-blood investigations for falls?
ECG
Lying and standing BP
ECHO
tilt table test
24 hour tape
Imaging (for injury)
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
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
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
what are the 3 different types of delirium?
hyperactive
hypoactive
mixed
what are 6 risk factors for delirium?
dementia
comorbidities
physical frailty
older age
sensory impairment (blind/deaf)
polypharmacy
what are 7 causes of delirium? mneumonic
PINCH ME
Pain
Infection
Nutrition
Constipation
Hydration
Medication
Environment
Also - alcohol withdrawal, metabolic disturbance
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
what medication can be used if a delirious patient is aggitated?
1 - haloperidol 0.5mg
what medication should be used in an aggitated patient with parkinsons or lewy body dementia?
lorazepam
what screening test can be used to screen for delirium?
4AT
what is the 4AT test?
for delirium
Alertness
Age, DOB, Place, Year
Attention - months backwards
Acute change or fluctuating course
what is multimorbidity?
presence of two or more long term health conditions
what questionnaire can be used to assess frailty?
PRISMA-7
what tool can be used to identify medications that should/should not be used in the elderly?
STOPP/START tool
