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Health problems in older adults Flashcards

1
Q

Delirium defined

A

sudden state of rapid changes in brain fx
confusion
changes in cognition, activity and LOC

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2
Q

Dementia defined

A

slowly developing impairment of intellectual of cognitive fx that is progressive and interferes with normal fx

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3
Q

Etiology of Delirium

A

precipitated by an acute underlying cause

acute illness

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4
Q

Etiology of dementia

A

various causes

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5
Q

onset of delirium

A

abrupt over hours to days

rapid progression

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6
Q

onset of dementia

A

insidious onset with good days and bad days

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7
Q

memory with delirium

A

impaired but able to recall

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8
Q

memory with dementia

A

memory loss, especially recent memories

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9
Q

duration of delirium

A

hours to days

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10
Q

duration of dementia

A

months to years

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11
Q

sleep disturbance with delirium

A

sun downers

worse as day progresses

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12
Q

sleep disturbances with dementia

A

day-night reversal

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13
Q

phychomotor changes with delirium

A

hyperkinetic of hypoactive or mixed

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14
Q

phychomotor changes in dementia

A

not until late

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15
Q

Can delirium and dementia co-exist

A

yes

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16
Q

Drugs that could cause delirium

A 
anticholinergics (TCAs, antihistamines)
neuroleptics
opioids
benzos
alcohol
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17
Q

Other acute causes of delirium

A 
electrolyte disturbance
low PO2
UTI
pneumonia
urine retention
dehydration
cardiac trouble
subdural hematoma
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18
Q

Types of dementia

A

Alzheimer type
Vascular
parkison

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19
Q

Evaluation of someone with mental changes should include

A

start with history and physical exam

labs as needed

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20
Q

Lab for mental changes

A 
BUN/Cr
Glucose
Calcium
Sodium
Heptatic enzymes
Vit B12
TSH
RPR
CBC
UA
ECG
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21
Q

Tx in slow decline in AD

A

Vit E 1000 IU twice daily or selegiline 5mg twice daily

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22
Q

Tx in mild to mod AD

A

cholinesterace inhibitors
donepezil
ribastigmine
galantamine

these increase acetylcholine

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23
Q

Tx of mod to severe AD

A

N-metyl D-aspartate receptor antagonist (Namenda)

blocks glutimate

24
Q

Dementia and Depression

A

40% have both

tx with standard antidepressants

25
most common S/E of cholinesterase inhibitors
nausea and diarrhea
26
you are at increase risk for these if you take antipsychotics
stroke or other cardiovascular events
27
Normal changes in memory with aging
forget names or appts, but remember later occasional errors with check book occassionally needing help to perform a task occassionally getting the date wrong vision changes related to cataracts trouble finding the right word at times misplacing an item, but can retrace steps
28
Why to avoid nitrofuratoin (macrobid) in elderly
lack of efficacy in impaired renal fx
29
why avoid zolpidem (ambien) in the elderly
increase fall risk
30
why to avoid amitriptyline in elderly
risk of orthostatic hypotension
31
why to avoid diclofenac in elderly
potential to promote fluid retention
32
why to avoid sertraline in elderly
risk for hyponatremia
33
What medication is preferred over glipizide for DM in elderly
glyburide because of kidney fx
34
Common causes of syncope
vasocagal response from fear, pain, anxiety, pooping cardiac causes: cardiomyopathy, aortic dissection, dysrhythmia orthostatic hypotension from dehydration or meds such as CCB, diuretics, TCAs, ED meds
35
An elderly woman complains of a catch or cramp in her lower posterior legs that is relieved by rest. What would you find on exam
diminished bilateral pedal pulses with thinning of the skin from an arterial vascular issue
36
Strategies to improve functional performance in dementia
behavior modification such as scheduled toileting practice and positive reinforcement to increase functional independance music during meals or bathing light exercise
37
1st symptoms of vascular dementia
falls focal weakness disorientation anxiety/depression
38
1st symptoms of lewy body dementia
fluctuation presentation visual hallucinations sleep disorder falls
39
1st symptoms of frontotemporal dementias
insidious onsent personality changes poor judgement
40
Risk factors for Alzheimers dementia
``` female AA or hispanic down syndrome depression cardiac history ```
41
Risk factors for vascular dementia
male increasing age HTN smoking
42
Risk factors for lewy body dementia
Men | ApoE E4 allelle
43
Risk factors for frontotemporal dementia
familiar risk
44
Scientific base for Alzheimers dementia
neuritic plaques | neurofibrillary tangles and synaptic loss through out the cerebral cortex and limbic system
45
Scientific base for vascular dementia
cortical and subcortical infarcts
46
Scientific base for Lewy body dementia
lewy bodies in the cortical and subcortical areas of the brain EEG can help distiguish between AD and LB
47
Scientific base for frontotemporal dementia
"Pick's disease" | marked frontal and temporal lobe atrophy
48
Tx of vascular dementia
cholinesterase inhibitors may help | tx the vascular risks suchs at the HTN, dyslipidemia
49
Tx of Lewy body dementia
Tx depression with anticholinesterase
50
Tx for fronotemporal dementia
SSRI for depression | risperidone for behavior problems
51
Course of illness with AD
6-9 year life span after dx
52
course of illness with vascular dementia
shortens life span by 3 years
53
course of illness with lewy body dementia
6 year life span
54
course of illness with frontotemporal dementia
generally slow progression
55
Treatable causes of urinary incontinence in elderly
DIAPPERS acronym ``` Delirium Infection Atrophic urethritis Pharmaceuticals Psychologic disorders Excessive urine output Restricted mobility Stool impaction ```

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