Medicine for the elderly Flashcards
what is delirium
an acute deterioration in mental functioning arising over hours or days that is triggered mainly by acute medical illness, surgery, trauma or drugs
risk factors for delirium
elderly pre - existing cognitive impairment post operative sensory impairment previous history depression polypharmacy drug/alcohol dependance
Causes of delirium
D - drugs
E - electrolyte disturbance - hyponatraemia
L - lack of drugs (withdrawal)
I - infection
R - reduced sensory input, pain
I - intracranial - stroke/subdural haemorrhage
U - urinary retention/constipation
M - metabolic - acute kidney injury, hypocalcaemia, hypothyroid
what is the onset time for delirium
sudden (hours/days)
what is the course of delirium symptoms like
short and fluctuating
how long does an episode of delirium last
hours to less than a month
what are signs of delirium
Hyperactive - agitation and restless
hypoactive - slow and sleepy
what is someone with deliriums perception like?
distorted
illusions and hallucinations (often visual)
delusions
what diagnosis tools/investigations are there for delirium
4 - AT scoring CAM - confusion assessment method Full history Full exam - neuro, MSK, check for pain Basic Obs GLUCOSE Medication review Bloods - FBC, U&E, LFT, CRP, calcium, B12/folate, Mg, TSH, glucose Blood cultures - if septic ECG Imaging Bladder scan CT head?
Management of delirium
Rehydrate if necessary
Bowel chart
sensory input - glasses, hearing aids
1st line - haloperidol 500ug orally (or IM)
- NOT in hx of parkinsons or lewy - use lorazepam 500ug
Reasons an elderly person is more likely to fall
smaller pupils, lens thickening Slower reaction time Decreased cardiorespiratory fitness Loss of muscle mass and function Loss of peripheral sensation
What kind of medications can cause increased falls risk in elderly
Diuretics
Anti - hypertensives
(however can preserve use of ACEi and B blockers)
Sedatives
Anti - cholingergics
Hypoglycaemic agents
Psychotropic drugs
Antidepressants/antiphsychotics can cause orthostatic hypotension
Phenytoin
Alpha blockers - used in BPH - cause orthostatic hypotension
when a patient is admitted with a fall what are important assessments to do along side your other investigations
Cognitive assessments
4 AT, CAM, MMSE
Management of orthostatic hypotension
Stop culprit drugs - pregabalin, anti - hypertensives, anti-depressants, alpha blockers, diuretics Avoid sudden changes in move Water loading - first thing in am Increase salt diet Legs elevated
Fludrocortisone, midodrine
What are some investigations for falls patients
ECG bloods check blood sugar postural BP timed up and go echo CT head - if drop in GCS - signs of skull base fractures - panda eyes/battle's sign, CSF leakage - episodes of vomiting dix - hallpikes osteoporosis risk
