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KFP study > Older adult health and aged care > Flashcards

Older adult health and aged care Flashcards

1
Q

Conditions That qualify for MBS rebate on DEXA scans

10 conditions

A

Premature menopause
Hypogonadism
Rheumatoid arthritis
Hyperthyroidism
Hyperparathyroidism
CKD
CLD
Coeliac or other malabsorption
Glucocorticoid use
Anti-androgen therapy

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2
Q

Strategies to prevent Minimal Trauma Fractures?

A

Implement Falls prevention
Increase weight bearing exercise 2-3 sessions a week
Balance training such as Taichi
Adequate Calcium intake
Ensure enough Vitamin D
Stop smoking
Limit alcohol to 2 SD /day
Maintain ideal body weight BMI 18-25

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3
Q

What is adequate calcium intake?

A

1300 mg in patients taking drug therapy for osteoporosis
1300 mg in women older than 50 years and men older than 70 years
1000 mg in women 50 years or younger and men 70 years or younger.

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4
Q

What is adequate Vitamin D intake?

A

Cholecalciferol 25-50 microg orally, daily

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5
Q

How do you prevent falls?

5 answers

A

Regular optometry assessment for vision

Adjusting drug therapy if possible

Minimising household risks

Providing aids for daily living

Minimising periods of immobility

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5
Q

How do you prevent falls?

5 answers

A

Regular optometry assessment for vision

Adjusting drug therapy if possible

Minimising household risks

Providing aids for daily living

Minimising periods of immobility

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6
Q

list causes of faecal incontinence?

(7)

A

Faecal impaction, can be due to low hydration, constipation, low fibre

Reduced bowel emptying- due to reduced relaxation of sphincter

Neurogenic incontinence (severe stroke or severe dementia)

Anal sphincter or pelvic muscle weakness (e.g. after surgery)

Loose bowel motions (diarrhoeal illness or change in diet)

Colorectal disease

functional issues (not enough time to reach toilet)

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7
Q

Important points in history taking for faecal incontinence?

A
  1. type, use a bristol stool chart
    include a 7 day diary
  2. Frequency
  3. Timing
  4. Associated symptoms
  5. Is there constipation, straining, or pain on defecation or local symptoms
  6. Effect of life/quality
  7. Dietary history and appetite
  8. Comorbidiites
  9. Cognitive status and mobility
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8
Q

Investigations for faecal incontinence?

A

Abdominal XRAY- to exclude faecal loading

Stool MCS and C.diff if there is no other clear cause

Colonoscopy if sinister causes suspected (may not be appropriate as holistic management in aged care)

Malabsorption syndrome screening (lactose, gluten, fat, carbohydrate) IF there seems to be a dietary association

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9
Q

Basic measures to help manage faecal incontinence?

(4)

A

Encourage regular bowel actions, say after a meal in the morning
Can be stimulated by trained professionals - massaging towards the rectum

Encourage adequate dietary fibre
and fluid intake (may take dietician). E.g bulking agents like psyllium

Promote optimisation of toilet or commode access

Advise regular exercise (within scope of comorbidities)

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10
Q

Medications to treat constipation include?

A

Stool softeners (docusate)

osmotic laxatives (lactulose)

Stimulants (senna, bisacodyl)

Suppositories (bisacodyl, gylcerine)

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11
Q

Severe constipation managment?

A
  1. If impacted on exam
    use suppositories ASAP or micro enemas
  2. If no impaction but history and or XRAY shows faecal loading then use oral macrogol (movicol) up to 8 sachets over 6 hours - not for more than three days in a row
  3. if none of the above work then consider manual dis-impaction.
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12
Q

Unique treatments for faecal incontinence?

(4)

A

surgical sphincter repair

peri anal bulking agents

sacral neuromodulation

tibial nerve stimulation

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13
Q

Skin care is crucial in the management of incontinence, and includes:

(4)

A

regular checks to ensure the skin is clean and dry

washing skin with soap-free cleanser or soap alternative

regular pad changes

application of barrier cream.

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14
Q

Which types of medications are particularly problematic in terms of falls?

(7)

A

Antidepressants
Benzodiazepines
Anti-hypertensives
Anticholinergics
Hypoglycemics (insulin, gliclazide)
Class 1A anti-arhythmic drugs (Flecanide, lidocaine)
Neuroleptics (aka first gen anti-psychotics like haloperidol)

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15
Q

What is important about Vitamin D in osteoporosis and falling?

A
  1. need adequate levels to optimise bisphosphonate therapy
  2. while it doesn’t reduce the risk of falling, it does reduce the rate of falling
16
Q

In an elderly person (>65) with abdominal pain and diarrhoea what is the diagnosis not to be missed, especially if their PMH includes AF ?

A

Mesenteric Ischemia.

AF is a big risk factor for mesenteric ischemia as is left ventricular stasis or aneurysm.

Usually there is diarrhoea or vomiting first due to ‘gut emptying’ so don’t presume this is a viral gastroenteritis.

17
Q

Causes of urinary incontinence in aged care?

DIPPERS

A

DIPPERS

Delirium
Infection
Pharmaceuticals
Psychological
Excess fluid
Restricted Movement
Stool impaction

18
Q

What medications may affect/exacerbate the following incontinence issues in the elderly?

Stress
Urge
Chronic retention
Functional incontinence

A

Stress - prazosin, tamsulosin

Urge -SSRIs, anti-cholinergics, diuretics

Chronic retention- opioids, verapamil

Functional incontinence - psychotropics, analgesics

19
Q

Lifestyle management for Urinary Incontinence

(list 5, there are about 10)

A

appropriate fluid intake
limit caffeine and alcohol
minimise evening fluid intake
treatment of constipation
regularly toileting times with good posture to encourage complete emptying
Bladder retraining in cognitively capable persons for urge incontinence
Pelvic floor exercises
Toileting assistance
Incontinence products (pads, disposable pants)
Mobility aids (beside comodes, over toilet frames)

20
Q

In what vulnerability groups or situations should prompt a GP to review medications in older adults?

there is an extensive list, name at least 5.

A

History of falls

Recent discharge from hospital

Patients taking more than 5 regular medications

Taking > 12 doses of medication/day

Multiple chronic conditions

High risk drug groups e.g. Narrow therapeutic range

Anticholinergic load

Patients who attend multiple doctors/clinics

Confusion or dementia

21
Q

What should be considered during a medication review?

A
  1. Anticholinergic load of the medications
  2. Try to reduce the total amount of medications
    “deprescribing”
  3. Screening for side effects particularly falls and cognitive impairment
  4. Review of the sedative load
  5. Consideration of webster packaging
22
Q

What are the recommendations for exercise in older adults

A

Should do some form of exercise irrespective of age, weight, health problems or abilities

Be active in a variety of ways: cardiovascular fitness, strength, balance and fitness

Should incorporate at least 30 minutes of moderate intensity physical exercise every day of the week

If they have stopped exercising then to restart at a suitable level and build up gradually

23
Q

What should you ask for in history if someone is deemed a higher falls risk?

A

Detailed history of falls that have occurred, where, how many, precipitating factors

Medications

Impaired gait?

Foot pain or deformities

home hazards

vision

incontinence

recent discharge from hospital

Chronic neurological illnesses: parkinson’s, dementia, stroke, MS

Vitamin D deficiency

24
Q

What in room test can you use to help determine a high falls risk?

A

6 metre walk test

time it takes to sit up from chair, balance walk 3 meters and three metres back as well as sit back down

> 18 seconds indicates an increased falls risk

OR

Alternate step test
Stepping up to a 18cm high step 8 times (4 each side)

> 10 seconds indicates higher falls risk

25
Q

Physical examination - what should it include in a falls assessment?

A
  1. gait
  2. Visual acuity
  3. Visual fields
  4. cardiac dysarrhythmias
  5. postural hypotension
  6. 6 metre walk test
  7. neurological impairment (limb neuro exam)
26
Q

What are the exercise recommendations specifically to prevent falls

(4)

A
  1. exercise that specifically challenges balance
  2. needs to be done for 2 hours or more a week as a continuous lifetime activity
  3. Falls prevention can be home based or group based
  4. Walking or strength training alone (one without the other) is not sufficient to prevent against falls
27
Q

Falls risk prevention activities?

(5)

A
  1. home or exercise based exercise program

If unsteady or higher risk then refer to a trained professional

  1. Regular medication review; anticholinergic, sedatives, psychoactive drugs and hypotensive causing agents
    -consider pharmacy review
  2. Home assessment for moderate to high falls risk by an OT
  3. regular optometry
  4. podiatrist for foot care
  5. manage incontinence
  6. Vitamin D 1000-2000 IU a day, orally
28
Q

when to consider a referral for falls?

A

Frequency:
2+ falls in the last 12 months

Clinical features
-Unexplained falls with presyncope, dizziness or poor recall (may even get a cardiologist involved)
-Falls as part of a down spiral in physical, social and mental health
-Falls occurring as part of a low threshold (activities of daily living)
-Falls with head injury, low trauma fracture or on the floor for> 1 hour
-Gait disturbance or unsteadiness present

29
Q

Prevention and early intervention activities with regards to dementia?

(8)

A
  1. Adequately address cardiovascular diseases
  2. exercise 150minutes moderate intensity activity a week
  3. Cognitive training and rehabilitation
  4. Social engagement (more social activities)
  5. Smoking cessation
  6. Promote the mediterranean diet
  7. Practice good sleep hygiene
  8. Reduce alcohol intake
30
Q

How might you be alerted to or screen for dementia?

A

Form 65 years and older be alert to dementia

  1. Can ask “how is your memory”
  2. obtain history from others regarding the person:
    - are they repeating questions
    - are they forgetting conversations
    - are they double buying/purchasing
    - are there unpaid bills
    - is there social withdrawal
  3. Other cues
    missed appointments (ask reception)
    Change in medication compliance
    Observable deterioration in grooming/dressing
31
Q

What are routine tests for dementia?

A

FBC
ESR
CT brain
Thyroid function
B12 and folate
Calcium
LFTs

surprisingly EUC and kidney function are not included.

32
Q

What are the cut off scores on MMSE for dementia?

A

> 24 is normal

21-24 Mild Alzheimers

10-20 Moderate Alzheimers

<10 Severe Alzheimers

33
Q

what basic forms of cognitive stimulation can you offer patients?

A
  1. suduko
  2. crosswords
  3. brain teasers
  4. taking up new skills
34
Q

What medication can be offered for Alzheimers dementia?
How is it started?
How useful is it?

A

Can use anti cholinesterase inhibitors.

e.g. Donepezil 4mg orally, nocte for 4 weeks then increase to 10mg, orally nocte if tolerated

also rivastigmine

These need to be started by a geriatrician initially in order to get the PBS subsidy

KFP study (31 decks)

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