Older Adults

Question 1

What non-pharmacological intervention should be offered to patients with mild-moderate dementia to promote cognition, independence and well being?

Answer 1

Group cognitive stimulation therapy

can consider group reminiscence therapy
consider cognitive rehab and OT to support functional ability

Question 2

When should Memantine monotherapy be offered to patients with dementia?

Answer 2

If moderate Alzheimer’s disease in person intolerant of AChE inhibitors OR
severe Alzheimer’s disease

consider in addition to an AChE inhibitor in those with moderate disease and offer in addition to those with severe disease

Question 3

Pharmacological tx of Lewy Body Dementia?

Answer 3

Offer donepezil or rivastigmine in mild to moderate lewy body dementia, only consider galantamine if these are not tolerated.

Can consider memantine if AChE inhibitors not tolerated or CI

Question 4

Minimal duration of reassessment if starting patient with dementia on antipsychotics?

Answer 4

6 weeks

Question 5

NICE recommended drug management of parkinsons disease dementia?

Answer 5

• offer a cholinesterase inhibitor if mild or moderate parkinsons disease dementia-only licensed medication is rivastigmine
• consider cholinesterase inhibitor in severe parkinsons disease dementia

Question 6

What are the 4 specific components to a multifactorial intervention programme for older people with recurrent falls or assessed as being at increased risk of falling?

Answer 6

• strength and balance training
• home hazard assessment and intervention
• medication review with modification/withdrawal
• vision assessment and referral

Question 7

Which men require f/u scanning after screening US at age 65 for a AAA?

Answer 7

if small AAA (3-4.4cm)-annual scans

if medium AAA (4.5-5.4cm)-3 monthly scans

Question 8

Proportion of older adults aged 65 and over having a fall each year?

Answer 8

about 30%

increasing to 50% in people aged 80 and older

Question 9

After a first fall, what is the risk of an older person having another fall in the next year?

Answer 9

66%

ALWAYS ask about hx of previous falls-strong RF for further falls

Question 10

Proportion of falls in older people resulting in a fracture?

Answer 10

5%

Question 11

Tests to assess gait in patients aged 65 and over at risk of falls?

Answer 11

timed up and go test

turn 180 degrees test

Question 12

Which patients aged 65 and over should be offered a multifactorial falls risk assessment?

Answer 12

• if had 2 or more falls in last 1 year OR
• present for medical attention following a fall OR
• cannot perform or perform poorly on the timed up and go test and/or turn 180 degrees test

if pt does not have an indication to be referred then reassess need to refer at least annually.

Question 13

What is observed in the timed up and go test?

Answer 13

time taken for pt to stand up out of chair without using their arms, walk 3 metres, turn around, return to chair and sit down.

a score of 12-15 seconds or more=indicates high risk of falls in older people

Question 14

When should further assessment be considered following the result of the turn 180 degrees test?

Answer 14

if pt takes more than 4 steps to step around until they are facing the opposite direction