Older adult health and aged care Flashcards
Conditions That qualify for MBS rebate on DEXA scans
10 conditions
Premature menopause
Hypogonadism
Rheumatoid arthritis
Hyperthyroidism
Hyperparathyroidism
CKD
CLD
Coeliac or other malabsorption
Glucocorticoid use
Anti-androgen therapy
Strategies to prevent Minimal Trauma Fractures?
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
What is adequate calcium intake?
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.
What is adequate Vitamin D intake?
Cholecalciferol 25-50 microg orally, daily
How do you prevent falls?
5 answers
Regular optometry assessment for vision
Adjusting drug therapy if possible
Minimising household risks
Providing aids for daily living
Minimising periods of immobility
How do you prevent falls?
5 answers
Regular optometry assessment for vision
Adjusting drug therapy if possible
Minimising household risks
Providing aids for daily living
Minimising periods of immobility
list causes of faecal incontinence?
(7)
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)
Important points in history taking for faecal incontinence?
- type, use a bristol stool chart
include a 7 day diary - Frequency
- Timing
- Associated symptoms
- Is there constipation, straining, or pain on defecation or local symptoms
- Effect of life/quality
- Dietary history and appetite
- Comorbidiites
- Cognitive status and mobility
Investigations for faecal incontinence?
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
Basic measures to help manage faecal incontinence?
(4)
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)
Medications to treat constipation include?
Stool softeners (docusate)
osmotic laxatives (lactulose)
Stimulants (senna, bisacodyl)
Suppositories (bisacodyl, gylcerine)
Severe constipation managment?
- If impacted on exam
use suppositories ASAP or micro enemas - 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
- if none of the above work then consider manual dis-impaction.
Unique treatments for faecal incontinence?
(4)
surgical sphincter repair
peri anal bulking agents
sacral neuromodulation
tibial nerve stimulation
Skin care is crucial in the management of incontinence, and includes:
(4)
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.
Which types of medications are particularly problematic in terms of falls?
(7)
Antidepressants
Benzodiazepines
Anti-hypertensives
Anticholinergics
Hypoglycemics (insulin, gliclazide)
Class 1A anti-arhythmic drugs (Flecanide, lidocaine)
Neuroleptics (aka first gen anti-psychotics like haloperidol)
What is important about Vitamin D in osteoporosis and falling?
- need adequate levels to optimise bisphosphonate therapy
- while it doesn’t reduce the risk of falling, it does reduce the rate of falling
In an elderly person (>65) with abdominal pain and diarrhoea what is the diagnosis not to be missed, especially if their PMH includes AF ?
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.
Causes of urinary incontinence in aged care?
DIPPERS
DIPPERS
Delirium
Infection
Pharmaceuticals
Psychological
Excess fluid
Restricted Movement
Stool impaction
What medications may affect/exacerbate the following incontinence issues in the elderly?
Stress
Urge
Chronic retention
Functional incontinence
Stress - prazosin, tamsulosin
Urge -SSRIs, anti-cholinergics, diuretics
Chronic retention- opioids, verapamil
Functional incontinence - psychotropics, analgesics
Lifestyle management for Urinary Incontinence
(list 5, there are about 10)
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)
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.
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
What should be considered during a medication review?
- Anticholinergic load of the medications
- Try to reduce the total amount of medications
“deprescribing” - Screening for side effects particularly falls and cognitive impairment
- Review of the sedative load
- Consideration of webster packaging
What are the recommendations for exercise in older adults
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
What should you ask for in history if someone is deemed a higher falls risk?
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
