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
