Older Person's Medicine Flashcards
What do the domains of a comprahensive geriatric assesment include?
Problem list- current and past Medication review Nutritional status Funcational capacity Social circumstances Environment
What is a CGA?
Multidimensional, interdisciplinary, diagnostic process to determine the medical, psychological, and functional capabilities of a frail older person in order to develop a coordinated and intergrated plan for treatment and follow-up.
What do the numerical values of the clinical frailty score indicate?
1 Very fit
2 Well
3 Managing well (not active beyond routine walking)
4 Vulnerable (not dependent on other but symptoms limit activities)
5 Mildly frail (need help in high order IADLs)
6 Moderately frail (requiring help with all outside activities, minimal assistance with ADLs)
7 Severely frail - dependent on others for personal care
8 Very severely frail - completely dependent on othersm approaching end of life)
9 Terminally Ill (<6 months life expectancy)
What is frailty?
Distinctive health state in which multiple body systems gradually lose their inbuilt reserves and this group of people are at higher risk of adverse health outcomes.
How many drugs prescribed at any one time constitutes ‘polypharmacy’?
6 or more
What tool can be utilised during a medication review, particularly when perforoming a CGA?
STOPP/START tool
What are the 4 criteria for capacity?
- able to understand the information
- able to retain the information given
- able to use this information to make their decision
- able to communicate this decision back
How can capacity be maxamised?
Discuss the options in a time and place that helps them to understand and remember what you say.
Ask whether having a friend or relative with them might help them to remember information, or otherwise help them make the decision.
Offer written or audio information if it will help.
Speak to the patient’s relatives, friends, and others in the healthcare team, about how best to communicate with the patient.
What are the signs that a patient is reaching the end of their life?
Bedbound
Unable to swallow medication
Unable to take sips of water
Semi-comatose state
What symptoms may a patient experience at the end of their life?
Pain Nausea and vomiting Dysponea Adgitation Confusion Terminal Secretions Constipation Anorexia
What are common anticipatory end of life medications?
Medicine for pain – an appropriate opioid, for example, morphine, diamorphine, oxycodone or alfentanil.
Medicine for breathlessness – midazolam or an opioid.
Medicine for anxiety – midazolam.
Medicine for delirium or agitation – haloperidol, levomepromazine, midazolam or phenobarbital.
Medicine for nausea and vomiting – cyclizine, metoclopramide, haloperidol or levomepromazine.
Medicine for noisy chest secretions – hyoscine hydrobromide or glycopyrronium.
What is a ReSPECT form?
Recommended Summary Plan for Emergency Care and Treatment
What is delirium?
Acute confusional state, with a sudden onset and fluctuating course.
May be hypoactive or hyperactive - recognised change in conciousness
Onset of 1-2 days.
CHANGE FROM BASELINE
Causes of delirum
Infection Intoxication Substance withdrawal Constipation Uncontrolled pain Hypoxia Electrolyte imbalance Urinary retention
What is dementia?
Progressive decline in cognitive function usually occuring over several months. It affects many different areas of function, including:
Retention of new information, managing complex tasks, language and word finding difficulty, behaviour, orientation, recognitiion, ability to self care, and reasoning
What are the most common types of dementia?
Alzheimers Vascular Lewy Body Parkinson's disease with dementia Frontotemporal dementia Mixed (Alzheimers and Vascular type)
How can Alzheimer’s be managed pharmacologically?
Cholinesterase inhibitors such as Donepezil
Antispychotic medications such as memantine or risperidone
Benzodiazapines such as lorazepam
Management of vascular dementia
Optimisation of vascular risk factors (stroke/tia)
What is the difference between Lewy Body dementia and Parkinson’s disease with dementia?
In Parkinson’s disease typical features of Parkinson’s will present and precede confusion by over a year
Lewy Body dementia Parkinsonism tends to be less severe
Both are progressive with prominent auditory or visual hallucinations, delusions are well formed and persistent
What are the main types of incontinence?
Stress
Urge
Overflow
Functional (cognitive impairment, behavioural problems)
What is required for a full continence examination?
Review of bladder and bowel diary
Abdominal examination
Urine dipstick and MSU
PR examination (including prostate in men)
External genitallia review (atrophic vaginitis in women)
A post micturation bladder scan
What is the firstline management for urinary incotincence?
Switching to decafinated drinks Good bowel habit Improving oral intake Regular toileting Pelvic floor exercises Bladder retraining
Why are pharmacological measures for urinary incontinence often contraindicated in older patients?
Antichollenergics adversely affect their cognition
Many of the drugs used for bladder stabalization can also cause postural hypotension leading to increased falls
When might you be suspicious of feacal impaction in a patient who is opening their bowels?
Small amount of type 1 stool
Copious amount of type 6/7 stool
No sensation of defecation
This could be overflow constipation
