Older persons Flashcards
What is a CGA?
Comprehensive geriatric assessment
Multidimensional evaluation of a frail patient to achieve optimal health
What is included in a CGA?
Physical assessment
Socioeconomic/environmental assessment
Functional assessment
Motility/balance assessment
Psychological/mental assessment
Medication review
Define frailty
Distinctive health state related to the ageing process in which multiple body systems gradually lose their in-built reserves
Phenotype model – describes a group of patient characteristics: unintentional weight loss, reduced muscle strength, reduced gait speed, self-reported exhaustion & low energy expenditure
-3 or more = have frailty
What is the clinical frailty score?
Scoring frailty in people with dementia
Degree of frailty corresponds to the degree of dementia
On a scale from 1-9
What is polypharmacy?
Use of 5 or more medications
-increased risk of falls
-reduces concordance
-increased adverse drug reactions
What is the START/STOPP criteria?
START – screening tool to alert to right treatment: used to prevent omissions of indicated, appropriate medicines in older patients with specific conditions
STOPP – aims to reduce the incidence of medicines-related adverse events from potentially inappropriate prescribing and polypharmacy
Define fall
An event which results in a person coming to rest inadvertently on the ground or floor or other lower level
All falls are accidental and mechanical
Falls are either syncopal or non-syncopal
List causes of falls
Intrinsic – vision, cognition, vestibular system, CVS, infections
Extrinsic – medications, walking aids, environment, other people, multitasking
List tests to do in a patient presenting with a fall
Bloods – FBC, U&E, LFT, bone, TFT, B12/folate, HbA1C, glucose
ECG
MSU/CSU (don’t dip urine in >65 or catheters)
Postural BP
Height and weight
List treatments for falls
Medication reviews
Treat ‘reversible’ causes: infection, electrolyte imbalance
Consider bone health & fracture risk management
MDT review – physiotherapy & occupational therapy
Define blackout
Transient loss of consciousness
Differentials: syncope, seizure/epilepsy, hypoglycaemia, drug/alcohol, sleep disorders, medication, undetermined
List causes of syncope
Vasovagal – simple faint; common and a result of vagal stimulation (pain, fright, emotion)
Peripheral factors – hypotension (commonest cause of syncope)
Carotid sinus hypersensitivity
Pump problem
Outflow obstruction
Describe the management of syncope
Treat any cause found and review/reduce medication
Fludrocortisone/midodrine for OH
Education
Driving – inform patient & document any driving advice given
Define delirium
An acute confusional state, with a sudden onset and fluctuating course
Develops over 1-2 days & recognised by a change in consciousness either hyper or hypoalert and inattention
List investigations to do for suspected delirium
Bloods – CRP, U&Es
Urine microscopy
PR examination
Describe the management of delirium
Supportive care
Treating to underlying cause & orientating them to time and place -> can take time to resolve & some people never get back to their baseline
Pharmacological treatment should be reserved for extreme cases
Define dementia
Progressive decline in cognitive functioning usually occurring over several months
Affects many different areas of function eg. retention of new information, managing complex tasks, language & word finding difficulty
List different types of dementia
Alzheimer’s dementia – most common, insidious onset with slow progression, diagnosed on clinical history but brain may show disproportionate hippocampal atrophy
Vascular dementia – suggestive imaging, step-wise progression
Dementia with Lewy Body – gradually progressive, auditory/visual hallucinations
Frontotemporal dementia – early onset & have complex behavioural problems, language dysfunction may also occur
Describe the management of dementia
Alzheimer’s – cholinesterase inhibitors
Vascular dementia – only the ability to modify risk factors
Describe the impact of incontinence in older people
One of the major factors leading older people to fall & require 24 hour care
NOT a natural part of the ageing process
Significant impact on mental health & wellbeing
Describe the management of urinary incontinence in older people
First line management – switching to decaffeinated drinks, good bowel habit, improving oral intake, regular toileting, pelvic floor exercises & bladder retraining
Pharmacological management can be trialled -> many drugs used can also cause postural hypotension leading to increased falls
Describe the management of constipation in older people
Utilising enemas for rectal loading
Stool softeners and stimulants
Manual evacuation is done in difficult cases
Any prescribed drugs that can cause constipation should be co-prescribed with a laxative
