Older Age - Ageing, Dementia, Falls & Frailty Flashcards
What is the difference between chronological age and biological age?
Chronological - actual age
Biological - health of body
What are the main respiratory effects of ageing?
- decreased elasticity and compliance
- total lung capacity, FVC, FEV1 and vital capacity are reduced
- increased risk of post-operative complications e.g. PE, pneumonia, atelectasis (lung collapse)
Why do you need to be cautious when giving opiates to elderly?
Opiates suppress CNS function which can lead to airway obstruction (elderly already at risk of airway obstruction due to reduced elasticity around oropharynx).
Why is it significant that elderly have reduced hepatic and renal function?
Slower metabolism and elimination of drug - can lead to toxicity.
Why does atrial fibrillation have a risk of collapse?
- atrial contraction contributes to 1/3 of normal ventricular filling
- patient with AF has reduced CO
- can lead to collapse due to low BP
What is ‘arm-brain’ time? How does it differ in elderly?
- time it takes for drugs to become effective
- increased in elderly due to decreased CO
How can decreased plasma proteins in the elderly result in toxicity/needs reduced dosage?
Results in decreased protein binding and therefore increased free drug availability.
Name 2 drug classes that are nephrotoxic.
ACEi
NSAIDs
How does hypertension cause HF?
Increased LV strain
LV hypertrophy
Heart failure
What is the average number of medications in the elderly population?
4
How is a diagnosis of dementia made?
- thorough Hx, Ex, cognitive assessment and MSE (mental state examination)
- blood tests (to exclude other underlying causes)
- imaging
What is the National Dementia Strategy?
National response to try to deal with increasing demands of dementia - includes medical schools having more teaching based around dementia.
What is malnutrition?
In-balance between what an individual eats and what they require to maintain health - includes over-eating and under-eating. Also includes incorrect balance of nutrients.
What are the effects of malnourishment in the elderly in hospital?
- increased risk of pressure sores
- more likely to have longer hospital admissions
- respond less well to treatment
- 3 times more likely to develop complications after surgery
- higher mortality rate
What is the most important thing to ascertain when someone has fallen.
Whether there was any loss of consciousness leading to the fall.
What is the difference between a syncopal and non-syncopal fall?
Syncopal - loss of consciousness caused the fall
Non-syncopal - syncope did not cause the fall, even if someone has loss of consciousness due to head injury following fall, this is still non-syncopal.
State some risk factors for falls.
- trip hazards
- septic/infection
- UTI
- MI
What are pre-syncopal symptoms?
Symptoms that precede a syncope e.g. Dizziness, chest pain, sweating, pallor, blurred vision.
Name the 3 main types of syncope.
1) Reflex syncope
2) Postural/orthostatic hypotension
3) Cardiac syncope
What is a reflex syncope?
Dysfunction of the autonomic NS which regulates blood pressure and heart rate, BP is not controlled e.g. Vasovagal, situational syncope (after coughing, urinating or weights), carotid sinus massage.
What is postural/orthostatic hypotension and how does it lead to syncope?
Pre-syncopal symptoms when standing from a sitting or lying position that progress to syncope. Standing causes blood to pool in legs, decreasing EDV, SV and CO. Baroreceptor reflex fails to maintain BP.
Which cranial nerves are the afferent and efferent branches of the baroreceptor reflex?
Afferent - glossopharyngeal
Efferent - vagus
What is cardiac syncope?
Syncope caused by cardiac disease or abnormality, can be:
- electrical - bradycardia or tachycardia
- structural - aortic stenosis
- coronary - MI/IHD
What main investigations should you do when someone presents at A+E after a fall?
- LSBP (lying standing BP)
- ECG
- FBC
- urea and electrolytes
- creatine kinase
Why should you measure creatine kinase in someone that has fallen?
This is the most reliable test to check for rhabdomyolysis, which is a common complication of falls with a ‘long-lie’.
What is rhabdomyolysis?
Release of intracellular ions, myoglobin, creatine and kinase and urates due to skeletal muscle damage caused by a crush injury or prolonged immobilisation e.g. A fall.
What is the frailty index score?
Frailty index score = number of deficits of an individual/total number of deficits measured.
E.g. In a dataset with 50 health deficits, if a person had 10 of these problems, they have a score of 0.2
How does a frail person react to the same insult as a fit person e.g. For flu?
A frail person is likely to have a much more profound deterioration and a longer recovery, they may also not completely recover to baseline.
Name some consequences of frailty.
- increased risk of falls, immobility, collapse or confusion
- cognitive impairment
- osteoarthritis
- depression
- deafness/blindness
