Older persons Flashcards
Comprehensive geriatric assessment
Multidimensional, interdisciplinary diagnostic process to determine the medical, psychological & functional capabilities of a frail older person in order to develop a coordinated and integrate plan for treatment and long-term follow-up
Leads to better outcomes, including reduced readmissions, reduced long-term care, greater patient satisfaction and lower costs
CGA domains
Problem list – current and past
Medication review
Nutritional status
Mental health – congition, mood and anxiety, fears
Functional capacity – basic activities of daily living, gait and balance, activity/exercise status, instrumental activities of daily living
Social circumstances – informal support available from family/friends, social network, eligibility for being offered care resources
Environment – home environment, facilities and safety within the home environment, transport facilities, accessibility to local resources
Polypharmacy
Occurs which is when 6 or more drugs are prescribed at any one time
What do discharges involve?
Medication to take home (TTO’s)
Transport
Therapy assessment – referral to community OT/PT if required
Restarting package of care
District nurse referral is required/palliative care or community lead referral if warranted
Transfer back letter for residential/nursing home
Frailty
Distinctive health state in which multiple body systems gradually lose their inbuilt reserves s& this group of people are most at risk of adverse health outcomes
Measured by clinical frailty scale (1 = very fit, 9 = terminally ill)
Delirium
Acute confusional state, with a sudden onset and fluctuating course
Develops over 1-2 days and is recognised by a change in consciousness either hyper or hypoalert & inattention
Delirium causes
PINCH ME
Pain
Infection
Nutrition
Constipation
Hydration
Medication
Environment
Dementia
Progressive decline in cognitive functioning usually occurring over several months
Affects many different areas of function including – retention of new information, managing complex tasks, language and word finding difficulty, behaviour, orientation, recognition, ability to self care & reasoning
Alzheimer’s dementia
Most common cause
Insidious onset with slow progression
Behavioural problems are common
Diagnosed on clinical history but brain imaging may show disproportionate hippocampal atrophy
Cholinesterase inhibitors – available to slow its progression
Vascular dementia
Second most common
Suggested by vascular risk factors
Imaging is suggestive vascular disease, often has a step wise progression
Management is based on modifying risk factors
Dementia with lewy body
Gradually progressive
Prominent auditory/visual hallucinations
Delusions are well formed and persistent
Parkinsonism (tremors, muscle rigidity & slowness of movement) commonly present but not severe
Parkinson’s disease with dementia
Typical features of Parkinson’s disease are present & precede confusion by over a year
Frontotemporal dementia
Onset often early
Complex behavioural problems, language dysfunction may occur
Urinary incontinence types
Stress incontinence – small volumes leak during coughing/laughing eg. most commonly in women
Urge incontinence – frequent voiding, often cannot hold urine; nocturnal incontinence is common, commonly seen with detrusor overactivity but can occur in obstruction
Overflow incontinence – due to urinary retention, seen with obstructive symptoms in men with enlarged prostates
Functional incontinence – due to cognitive impairment/behaviour problems
Complete continence examination
Review of bladder and bowel diary
Abdominal examination
Urine dipstick and MSU
PR examination including prostate assessment in a male
External genitalia review – look for atrophic vaginitis in females
Post micturition bladder scan
Faecal incontinence causes
Faecal impaction with overflow diarrhoea
Neurogenic dysfunction
Transient ischaemic attacks
Focal neurological deficits due to blockage of blood supply to a part of the brain lasting less than 24 hours
ABCD2 score
Risk assessment tool designed to improve the prediction of short-term risk of a stroke after a TIA
ABCD2 > 4 = higher risk
Age, BP, clinical features, duration of symptoms & presence of diabetes
TIA investigations & management
Investigations – blood tests, carotid doppler, brain scan (CT/MRI)
High risk – should be seen in a TIA clinic or by a stroke physician ASAP
Aspirin (300mg) started immediately
Treatment – lifestyle modifications, treatment of hypercholesterolaemia, hypertension, surgical intervention for carotid artery disease if appropriate & antiplatelets
Stroke
Can be defined as a sudden onset of a focal neurological deficit lasting > 24 hours or with imaging evidence of brain damage due to either infarction or haemorrhage
Stroke types
Total anterior circulation stroke (TACS)
Partial anterior circulation stroke (PACS)
Lacunar stroke (LAC)
Posterior circulation stroke (POCS)
Anticipatory medications
Pain – opioid (eg. morphine, oxycodone or alfentanil)
Breathlessness – midazolam/opioid
Anxiety – midazolam
Delirium/agitation – haloperidol, levomepromazine
N&V – cyclizine, metoclopramide, haloperidol/levomepromazine
Airway secretions (become too weak to cough/clear them) – hyoscine hydrobromide or glycopyrronium
