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Year 4 > Medicine - Geriatrics > Flashcards

Medicine - Geriatrics Flashcards

1
Q

What 4 domains are assessed in the comprehensive geriatric assessment?

A

Function and ability
Disease - severity and comorbidity
Mental health and cognition
Support networks and needs

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2
Q

Describe the members of the geriatric MDT and their roles:

A

PT - mobility, balance and limb function
OT - ADL, home environment, aids (walking aids, beds, chairs)
Dietician - nutrition
Speech and language therapist - communication, swallow screen
Social worker - care needs, discharge planning, organises institutional care
Nurses - pt education, skin care, assesses care needs before discharge, feeding, continence, communicates with relatives
Doctors - diagnosis/management of medical issues, co-ordinates assessment, plans rehab programme
Pharmacist - polypharmacy

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3
Q

Define a ‘fall’ in geriatrics

A

An unexpected event in which pt comes to rest on the ground/floor level
Is not a diagnosis in itself and must find a cause!

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4
Q

Describe categories of causes of falls in geriatrics

A 
Acute illness
CVS 
Blackouts
Gait/balance
Poor vision
Poor cognition
Vertigo
Drugs
Continence
Psychological
Environmental
Mechanical/recurrent falls
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5
Q

Give examples of ‘Acute illness’ which could cause a fall

A 
infection
stroke
sepsis
HF
drugs
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6
Q

Give examples of ‘CVS ‘ which could cause a fall

A

BP - orthostatic HTN
vasovagal episode
arrhythmia
structural (AS)

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7
Q

Give examples of ‘Blackouts’ which could cause a fall

A

Check BP and ECG

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8
Q

Give examples of ‘Gait/balance’ which could cause a fall

A

Neuro (DM, alcohol, folate)
Stroke/PD
Joints and feet -> muscle wasting, joints

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9
Q

Give examples of ‘Poor vision’ which could cause a fall

A

macular degeneration
glaucoma
DM
cataracts

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10
Q

Give examples of ‘Vertigo’ which could cause a fall

A

BPPV (benign positional paroxysmal vertigo)

Labyrinthitis

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11
Q

Give examples of ‘Drugs’ which could cause a fall

A

Sedatives
Abx
antihypertensives
antidepressants

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12
Q

Give examples of ‘Continence’ which could cause a fall

A

Urgency
Accidents
Immobility

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13
Q

Give examples of ‘Psychological’ which could cause a fall

A

Fear of falling -> shuffling cautious gait increases falls risk!

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14
Q

Give examples of ‘Environmental’ which could cause a fall

A

trip hazards

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15
Q

Give examples of ‘Mechanical/recurrent falls’ which could cause a fall

A

parkinsons
arthritis
stroke

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16
Q

Describe how falls are assessed/managed

A 
Referral to falls clinic
Nurse -> assess continence and meds, BP, ECG
Physio -> neuro/muscular assessment
Medical Hx and Ex
Psychologist
MDT!!
Home assessment
Minimise polypharmacy
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17
Q

Define urinary incontinence and its causes

A

involuntary loss of urine
F > M
Has stigma and embarrassment associated
Various causes: UTI, constipation, diuretics, hyperglycaemia, acute delirium

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18
Q

What are the 4 types of incontinence

A

Stress
Urge urinary
Overflow
Mixed

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19
Q

Describe stress incontinence and how it is managed

A

Weak pelvic floor muscles and intra-abdominal pressure > pelvic floor
Causes leakage when you cough/sneeze
E.g. due to childbirth/chronic coughing

Tx: conservative (exercises, reduce caffeine)
Surgery ?colosuspension
Pads

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20
Q

Describe urge urinary incontinence and how it is managed

A 
An overwhelming desire to void
cause not always known but can be due to:
- neurological complications
- small bladder capacity
remember to exclude UTI/cystitis

Tx: conservative (exercises, reduce caffeine)
Pharmacological - anticholinergics, B3 agonists
Invasive - botox, sacral nerve stimulation
Pads

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21
Q

Describe overflow incontinence and how it is managed

A

A full bladder which doesn’t empty properly due to an obstruction
Dribbling, interrupted flow, straining, no warning
Causes: = BPH, MS, constipation, neurological conditions

Tx: the cause, intermittent self-catheterisation, urosheath (like a condom)
Pads

22
Q

Describe mixed incontinence and how it is managed

A

Mix of urge and stress, Tx: pelvic floor exercises and pads

23
Q

What is another way in which incontinence can be split in 2 categories:

A

Functional - you know you need to wee but can’t get to the toilet in time (eg arthritis, mobility issues) = the urinary / bowel systems are intact

Passive - physically you could control your bladder, but cognition is impaired (e.g. and remember that toileting is a learned behaviour)

24
Q

What are complications of urinary incontinence?

A 
Falls, fractures
Social isolation
Depression
UTIs
Skin damage
25
Q

Define faecal incontinence and its causes

A 
involuntary passage of faeces/flatus 
multifactorial
prevalence under-recognised due to stigma
causes:
structural (sphincter trauma)
neuro (MS/stroke)
consistency altered
cognition
idiopathic
obstetric trauma
constipation
26
Q

How is faecal incontinence managed?

A

Diet advice
Suppositories/laxatives
Antimotility agents
Surgical review ?trauma

27
Q

Define delirium

A

Syndrome of transient reversible cognitive dysfunction which involves:

  • disturbance of attention/awareness
  • develops over a short time period
  • fluctuates
  • displays a change from baseline
28
Q

Compare and contrast delirium and dementia in the following domains:

1) onset
2) course
3) conscious level
4) cognition
5) hallucinations
6) delusions
7) psychomotor

A

Delirium:

1) acute/subacute
2) fluctuating
3) clouded
4) memory and attention affected
5) common (visual)
6) fleeting/persecutory
7) increased/reduced activity

Dementia:

1) insidious
2) progressive
3) clear
4) any area affected, especially memory
5) usually absent
6) usually absent
7) can be normal

29
Q

What are predisposing and precipitating factors in delirium?

A

Predisposing: male, older age, depression, dementia, alcohol, sensory impairment

Precipitating: polypharmacy, surgery, dehydration, malnutrition, sleep deprivation

30
Q

What are predicting factors which cause delirium to be missed

A 
The hypoactive subtype
Older age
Sensory impairment
Prevalent dementia
Fragility
Not looking for it!
31
Q

How is delirium diagnosed?

A

1) DSM criteria (complex)
2) CAM (confusional assessment method)
3) 4AT (includes AMT4)
4) Single Q screening tool
5) Look for abnormal hand movements:
- flocillation (plucking from the air)
- carphology (plucking at clothes)

32
Q

Describe the management of delirium

A

Non-pharmacological: reduce RFx
- hydration, hearing aids, avoid sedatives, immobility, repeated reorientation, lights set at the correct time of day
catheter? (urinary retention may be the cause)

Pharmacological: lorazepam, antipsychiotics

(Remember the TIME bundle: triggers?, investigate, manage, engage))

33
Q

Define dementia and its causes

A

Chronic, progressive, irreversible cognitive impairment due to brain disease

A - alzheimers
V - vascular
D - drugs/depression/delirium
E - ethanol
M - metabolic
E - endocrine (DM, thyroid)
N - neurological (fronto-temporal changes)
T - tumour, toxin, trauma
I - infection
A - autoimmune
34
Q

Describe alzheimers disease and its S/Sx

A

Gradual onset memory loss
Due to B-amyloid protein deposition in blood vessels and tau protein accumulation = neurotoxic

S/Sx: failing memory, cognitive decline, personality/mood changes, neurological abnormalities (postural changes)

35
Q

Describe vascular dementia and its S/Sx

A

acute onset, stepwise progression, CVD risk factors
Cause of death normally pneumonia

S/Sx: Memory impairment, multiple ischaemic lesions, lack of insight

36
Q

Describe lewy body dementia and its S/Sx

A

triad of: hallicinations, dementia, parkinsonism
accumulation of a-synuclein protein
lewy bodies then form in the dopaminergic system

S/Sx: progressive cognitive decline, fluctuating consciousness, visual hallucinations, parkinsonism

37
Q

Describe fronto-temporal dementia and its S/Sx

A

behavioural and language changes
usually there is a FHx and younger onset
Tau protein accumulation -> causes Picks bodies to form

38
Q

How is dementia investigated?

A 
Bloods (look for reversible causes)
Cultures (?infection)
ECG (?vascular)
SPECT scan (PD)
Cognitive testing:
- MMSE
- Addenbrookes
39
Q

What is the treatment of dementia

A

Non-pharmacological:

  • noise/light control
  • orientation
  • avoid triggers (don’t move ward)
  • fluid balance/diet
  • early mobilisation
  • limit staff changes
  • recognise frailty

Pharmacological:

  • antipsychotics
  • benzodiazepines
40
Q

What additional pharmacological treatments are available for Alzheimer’s disease?

A

Cholinesterase inhibitors = Donepezil (stops ACh breakdown and is thought to enhance ACh transmission and partially relieve Alzheimers symptoms)

Memantine = NMDA antagonist

41
Q

Describe malnutrition and the factors involved in its development

A

imbalance of energy/protein/other nutrients
Causes effects on body composition, physical functioning, and clinical outcomes
Factors involved:
- catabolic state (chronic illness, acute injury)
+ other factors: difficulty accessing food, can’t cook, poor dentition…

42
Q

Describe sarcopenia and the factors involved in its development

A

Geriatric syndrome of diminished muscle mass and function, often accompanied with unintentional weight loss
Can be primary (occurs naturally after 30yrs, and is accelerated after 60yrs) or secondary to acute illness/injury

43
Q

What is used to investigate and manage malnutrition

A

MUST score
Swallow screen ?eating difficulties

Encourage adequate food intake
Oral nutrition supplementation

44
Q

What are the 4 main classes of antidepressants

A

TCAs
SSRIs
Noradrenaline reuptake inhibitors
Monoamine oxidase inhibitors

45
Q

What are the risk factors for osteoporosis development?

A 
SHATTERED
steroids
hyperthyroid
alcohol
thin (low BMI)
testosterone (low)
early menarche
renal/liver failure
erosive bone disease
diet (low Ca/vit D)
46
Q

Describe pressure ulcers and risk factors for their development:

A

An area of localised skin injury, generally over a bony prominence
Occur in 30% of elderly hospitalised patients

RFx: immobility, malnutrition, sarcopenia, barrier impairment (eczema), local tissue hypoxia (DM, sepsis, PVD)

47
Q

What bacteria can infect pressure ulcers if they are not elevated?

A

pseudomonas aeruginosa

48
Q

Describe conductive causes of hearing loss

A 
WIDENING
wax/foreign body
infection (otitis media/externa)
drum perforation
ear bone discontinuation (trauma, osteosclerosis)
neoplasia
INjury (high air/water pressure)
Granulomatous (Wegners/sarcoid)
49
Q

Describe sensorineural causes of hearing loss

A 
DIVINITY
developmental 
degenerative
infection (meningitis, measles, mumps)
vascular
inflammation 
neoplasia
injury
toxins (gentamicin, furosemide)
lymph (meniere's disease)
50
Q

Describe elder abuse and what is may include

A

where there is an expected level of trust and there is repeated attacks/lack of appropriate actions causing harm/distress to an older person

5 domains:
Physical
Psychological
Financial
Sexual abuse
Neglect

Year 4 (28 decks)

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