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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
Q

most common S/E of cholinesterase inhibitors

A

nausea and diarrhea

26
Q

you are at increase risk for these if you take antipsychotics

A

stroke or other cardiovascular events

27
Q

Normal changes in memory with aging

A

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
Q

Why to avoid nitrofuratoin (macrobid) in elderly

A

lack of efficacy in impaired renal fx

29
Q

why avoid zolpidem (ambien) in the elderly

A

increase fall risk

30
Q

why to avoid amitriptyline in elderly

A

risk of orthostatic hypotension

31
Q

why to avoid diclofenac in elderly

A

potential to promote fluid retention

32
Q

why to avoid sertraline in elderly

A

risk for hyponatremia

33
Q

What medication is preferred over glipizide for DM in elderly

A

glyburide because of kidney fx

34
Q

Common causes of syncope

A

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
Q

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

A

diminished bilateral pedal pulses with thinning of the skin from an arterial vascular issue

36
Q

Strategies to improve functional performance in dementia

A

behavior modification such as scheduled toileting

practice and positive reinforcement to increase functional independance

music during meals or bathing
light exercise

37
Q

1st symptoms of vascular dementia

A

falls
focal weakness
disorientation
anxiety/depression

38
Q

1st symptoms of lewy body dementia

A

fluctuation presentation
visual hallucinations
sleep disorder
falls

39
Q

1st symptoms of frontotemporal dementias

A

insidious onsent
personality changes
poor judgement

40
Q

Risk factors for Alzheimers dementia

A 
female
AA or hispanic
down syndrome
depression
cardiac history
41
Q

Risk factors for vascular dementia

A

male
increasing age
HTN
smoking

42
Q

Risk factors for lewy body dementia

A

Men

ApoE E4 allelle

43
Q

Risk factors for frontotemporal dementia

A

familiar risk

44
Q

Scientific base for Alzheimers dementia

A

neuritic plaques

neurofibrillary tangles and synaptic loss through out the cerebral cortex and limbic system

45
Q

Scientific base for vascular dementia

A

cortical and subcortical infarcts

46
Q

Scientific base for Lewy body dementia

A

lewy bodies in the cortical and subcortical areas of the brain
EEG can help distiguish between AD and LB

47
Q

Scientific base for frontotemporal dementia

A

“Pick’s disease”

marked frontal and temporal lobe atrophy

48
Q

Tx of vascular dementia

A

cholinesterase inhibitors may help

tx the vascular risks suchs at the HTN, dyslipidemia

49
Q

Tx of Lewy body dementia

A

Tx depression with anticholinesterase

50
Q

Tx for fronotemporal dementia

A

SSRI for depression

risperidone for behavior problems

51
Q

Course of illness with AD

A

6-9 year life span after dx

52
Q

course of illness with vascular dementia

A

shortens life span by 3 years

53
Q

course of illness with lewy body dementia

A

6 year life span

54
Q

course of illness with frontotemporal dementia

A

generally slow progression

55
Q

Treatable causes of urinary incontinence in elderly

A

DIAPPERS acronym

Delirium
Infection
Atrophic urethritis
Pharmaceuticals
Psychologic disorders
Excessive urine output
Restricted mobility
Stool impaction

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