Older person mental health

Question 1

What is the difference between implied vs expressed consent?

Answer 1

Expressed = written / stated

Implied = actions imply

Question 2

What is the difference between advanced decision to refuse treatment (ADRT) and DNACPR?

Answer 2

ADRT = legally binding

DNACPR = to guide treatment

Question 3

What are the following questionnaires used for:

• MUST
• PHQ-9
• MMSE
• PRIMA-7
• NYHA

Answer 3

MUST = assess malnutrition

PHQ-9 = severity of depression symptoms

MMSE = cognitive impairment

NYHA = heart failure severity assessment

PRISMA-7 = to assess frailty

Question 4

What are some risk factors for multimnorbidity?

Answer 4

Increasing age

Female sex

Low socioeconomic status

Lack of physical activity

Question 5

What tips are there for polypharmacy?

Answer 5

Bisphosphonate holiday after 3 years = no evidence for continued benefit (discuss fracture risk)

Look to stop NSAIDS, warfarin and aspirin in those with peptic ulcer disease

Tricyclic antidepressants in pts with dementia

Haloperidol is contraindicated in patients with Parkinson’s (unlike domperidone which doesn’t cross BBB as much - use lorazepam instead)