Medicine for the Elderly

Question 1

What tests form the ‘confusion screen’?

Answer 1

FBC 
U+Es
TFTs
LFTs
Calcium
Glucose 
CRP
Folate
B12

Question 2

What is the management of the acute confusional state?

Answer 2

Supportive: Environmental; Nursing support
+
Tx underlying cause

± Refractory to nursing support; Deemed clinically needed
Sedative: Haloperidol

Question 3

What are the clinical features of Lewy-Body dementia?

Answer 3

Progressive cognitive impairment: cognition may fluctuate

Parkinsonism

Visual hallucinations

Question 4

What is the START tool?

Answer 4

used in patients with multiple morbidities, especially elderly patients, to decide whether the introduction of a new medication will be beneficial

Question 5

What is the STOPP tool?

Answer 5

assess which drugs can be potentially discontinued in elderly patients undergoing polypharmacy

Question 6

What is multi morbidity?

Answer 6

presence of two or more long term health conditions

Question 7

Give 5 RFs which increase your risk of multimorbidity.

Answer 7

Increasing age
Female sex
Low socioeconomic status
Tobacco and alcohol usage
Lack of physical activity
Poor nutrition and obesity

Question 8

What questionnaire can be used to assess frailty?

Answer 8

Comprehensive Geriatric Assessment

PRISMA-7 Qs - considers age, sex, health problems, assistance required etc etc

Question 9

What questionnaire may facilitate de-escalation of medication in elderly patients?

Answer 9

STOPP screening tool

Question 10

What questionnaire may be used in assessing medications that may provide additional benefits in elderly patients?

Answer 10

START tool

Question 11

What screening tool can be used to assess the risk of a patient developing a pressure area?

Answer 11

Waterlow Score

Question 12

How can you grade a pressure ulcer?

Answer 12

Grade 1 = non-blanchable erythema; discolouration of skin

Grade 2 = partial thickness skin loss, involving epidermis or dermis - superficial

Grade 3 = full thickness involving necrosing of subcutaneous tissue

Grade 4 = extensive destruction, tissue necrosis or damage to muscle, bone or supporting structures with or without full thickness skin loss

Question 13

How can you manage a pressure ulcer?

Answer 13

Supportive: Moist wound; barrier cream; dressings; swab
± Infection
Medical: ABX

± Resistant to ABX/ Clinical decision
Surgical: Debridement