Introduction to Geriatric Medicine Lecture Flashcards
What is gerontology?
Science of ageing
What proportion of people >75 arre in care homes?
7%
90 year-old lady with drowsiness and vomiting
- HxOA, HTN, dementia
- Rx: Amlodipine, Omeprazole
- Chest clear, abdomen SNT
- Severe AKI–CRP 11. Urine dip WC+, nit
- Initial CT Brain: age-related atrophy
- IVI, Broad spectrum antibiotics, USS Abdo
- AKI resolving with fluid and cessation of Rx
- USS was normal
- Vomiting persists
Likely underlying diagnosis?
- –A: Bacterial gastroenteritis
- –B: Drug side-effect
- –C: UTI
- –D: Viral encephalitis
- –E: Viral gastroenteritis
B - drug side effect, constipation from amlodipine
Intervention –>PR examination, enema, macrogol, medication review
Define frailty.
Frailty = a physiological syndrome characterised by decreased reserve and resistance to stressors, resulting from cumulative decline in multiple physiological symptoms, causing vulnerability to adverse outcomes.
List some factors that contribute to frailty.
Increased likelihood of adverse events and deterioration when they face minor stressors is due to these factors:
(Escpecially starting at a lower physiological reserve)
What is the CGA?
Comprehensive geriatric assessment (CGA) - Multidimensional interdisciplinary assessment that leads to individualised, goal based plan.
Who does the CGA benefit most? What are the benefits of using CGA in the community and hospital?
- CGA in the community
- Reduce admissions to institutional care
- Reduce falls
- Most benefit in mild or moderate frailty
- CGA for frail inpatients
- Reduces inpatient mortality
- Reduces functional and cognitive decline
- Reduces admission to institutional care
What are the two theories of why organisms age?
- Damage or error theories
- Programmed ageing theories
Describe the “damage or error” theory of ageing,
- Cause of ageing is the damage to DNA, cells and tissues e.g. loss of telomeres or oxidative damage.
- The theory holds that if we could prevent or repair this damage then we could prevent ageing
Describe the programmed ageing theory.
- Genetic, hormonal and immunological changes over the lifetime of an organism lead to cumulative deficits we see as ageing
- These theories of programmed ageing suggest that this is an inescapable part of a biological timetable just as growth and puberty are programmed to occur.
What are the main difficulties when managing disease in the elderly?
- Non-specific presentations
- Polypharmacy - with increasing drug use there are more drug interactions. Most drug evidence is extrapolated from young people.
- Multimorbidity - conditions impact on one another and treatment for one condition may impact another.
- Rehabilitation
Why do older people take more drugs?
- Multimorbidity
- Guidelines/QOF/NICE
- Undetected non-adherence – e.g. antihypertensives; patient doesn’t take it but you do not realise so you prescribe another
- Infrequent review
- Poor communication
What percentage of prescriptions are potentially inappropriate?
Up to 40%
What are the risk of polypharmacy in the elderly?
- Falls
- Increased length of stay
- Delirium
- Mortality
What changes can be seen in the brains of the elderly on MRI/CT?
- volume of cerebral spinal fluid within the surrounding brain increases with age
- ventricles enlarge
- gaps between the major gyri widen
When does the brain start to age and at what rate?
- Brain is at max weight at age 20
- At 40-50 years it decreases in weight at rate of 2-3% per decade
- At 80 years it is about 10% below maximum weight
What are the normal cognitive changes in older people?
- Processing speed slows
- Working memory slightly reduced
- Simple attention ability preserved, but reduction in divided attention
- Executive functions generally reduced
What cognitive aspects do not change with age?
- No change in nondeclarative memory
- No change in visuospatial abilities
- No overall change in language (some reduction in verbal fluency)
Why are rates of diagnosis of dementia low?
- Misinterpretation (it is normal for older people to have poor memory)
- Fatalism (we can’t do anything about it so what is the point of diagnosing)
- Social isolation - no one is there to notice the problems
Only 70% of people with dementia have a diagnosis.
What is dementia?
A chronic, progresive, degenerative disease which cause a decline in all domains of cognition.
What are the cognitive changes in dementia?
- Memory impairment but also:
- Loss of executive function
- Functional impairment
- Behavioural and psychological changes
- Lack of insight
Starts with memory problems but over time affects all cognitive functions.
What is deliriium?
- Acute global failure of higher brain functions (i.e. affecting alertness and cognition)= ACUTE BRAIN FAILURE.
- Delirium is an acute episode of confusion, usually with a clear precipitant such as infection or medication changes. Delirium usually resolves, but can leave some people with residual problems (ie dementia).
List the differences between dementia and delirium.
