Medicine in the Elderly* Flashcards
1
Q
3 areas of implications of ageing population
A
- healthcare costs
- social/homecare costs
- economic
2
Q
4 personality types of old people
A
- integrated: active, satisfied, flexible, functioning
- armouredL fights ageing, preoccupied with loss
- passive: dependent, low level of life satisfaction
- angry: low activity, low life satisfaction, bitter
3
Q
4 skin changes
A
- wrinkles
- dry
- cambell de morgan spots
- seborrhoic keratosis
4
Q
6 changes in mouth
A
- dec saliva production
- impaired mm mastication
- tooth loss
- decreased taste buds
- less sense of smell
- enlargement of tongue
5
Q
21 other physiological changes
A
- less hepatic drug metabolism
- less GFR (Glomerular filtration rate) 50%
- prostate enlargement
- decreased bladder capacity
- bone loss
- thickening of valves AS
- dilation of large elastic arteries
- increased systolic BP
- reduced stroke volume/ CO
- decline in carviovascular stress response
- fall in forced vital capacity FVC and FEV1 forced expiratory volume
- reduced brain weight
- presbyacusis (hearing loss)
- hardening of lens (impaired near vision)
- flatter cornea (astigmatism)
- reduced lean body mass
- increase fat mass
- impaired ability to maintain body temp
- reduced oestrogen levels
- inc immune deficiency
6
Q
4 IQ changes
A
- cross sectional studies suggest decline
- longitudinal studies suggest preserved
- verbal scores preserved
- tests requiring speed of response deteriorate
7
Q
5 specific features of disease presentation
A
- non specific presentation
- atypical presentation
- multiple pathology
- symptoms attributed to old age
- single illness leading to catastrophic outcome
8
Q
4 Is of non specific presentation
A
- Intellectual failure
- Incontinence
- Immobility
- Instability
9
Q
3 atypical presentations
A
- myocardial infarction without chest pain (dyspnoea, confusion, hypotension)
- infection without inc WCC or temp
- silent perforation (eg stomach ulcers
10
Q
6 symptoms erroneously attributed to old age
A
- hypothyroidism
- anaemia
- bowel problems
- urinary problems
- shortness of breath
- forgetfulness
11
Q
8 single illness leading to catastrophic consequences
A
- pneumonia
- delirium
- postural instability
- fall
- fracture neck of femur
- immobility
- DVT/ PE
- death
12
Q
5 physical signs of ageing
A
- small irregular pupils
- absent ankle reflexes
- reduced vibration sensation
- displaced apex (kyphoscoliosis)
- pulmonary crackles
13
Q
drug reaction stats
A
5-15% of hospital admissions caused by adverse drug reactions
6-17% have adverse drug reactions in hospital
14
Q
altered pharmacology with ageing 3
A
-less renal drug clearance
-variable changes to hepatic drug metabolism
-changes to volume of distribution
(use child doses)
15
Q
change in volume of distribution 3
A
- more fat, less lean muscle
- lipid soluble drugs have inc volume of distribution –> prolonged effect eg diazepam
- water soluble drugs have smaller volume of distribution –> more rapid peak eg digoxin
