Older Persons Flashcards
Features of comphrehensive geriatic assessment
Problem list - current and past
Medication review
Nutritional status
Mental health - cognition, mood, anxiety, fears
Functional capacity - basic activities of daily living, gait and balance, activity status
Social circumstances
Enviroment - home facilities, access to local resources
What is polypharmacy
6 or more drugs prescribed at any one time
What is delirium
Acute confusional state
- sudden onset and fluctuating course
- develops over 1-2 days
Causes of delirium
Underlying medical problem - infection - electrolyte imbalance - hypoxia - urinary retention - constipation Substance intoxication Substance withdrawal
Types of delirium
Hyperactive - agitated - confused Hypoactive - withdrawn - drowsy Mixed
What is dementia
Progressive decline in cognitive functioning usually occuring over several months
Features of Alzheimer’s dementia
Insidious onset with slow progression
Behavioural problems common
Diagnosed on clinical history but brain imaging may show disporportionate hippocampal atrophy
Progression reduced by cholinesterase inhibitors
Types of dementia
Alzheimer's Vascular Dementia with lewy body Parkinson's disease with dementia Frontotemporal dementia Mixed dementia
Features of vascular dementia
Vascular risk factors
Imaging of vascular disease
Step wise progression
Features of Dementia with Lewy Body
Gradually progressive
Prominent auditory or visual hallucinations
Delusions well formed and persistent
Parkinsonism commonly present but not severe
Features of parkinson’s disease with dementia
Typical features of parkinson’s disease are present and preced vonfusion by over a year
Features of frontotemporal dementia
Early onset
Complex behavioural problems
Language dysfunction
Types of incontience
Stress - small volumes during coughing/laughing
Urge - frequent voiding, cannot hold urine, noctural incontinence, detrusor overactivity and obstruction
Overflow - urinary retention, enlarged prostate
Functional - cognitive impariment of behavioural problems
Treatment of chronic diarrhoea
Faecal impaction excluded
Regualr toileting and dietary review
Low dose loperamide
What is a TIA
Transient Ischaemic Attack
- focal neurological deficits due to blockage of blood supply to part of the brain (focal brain dysfunction) lasting less than 24 hours
Features of ABCD2 tool
Assess short term risk for stroke/TIA - >4 = higher risk
- age
- blood pressure
- clinical features
- duration of symptoms
- diabetes
Post TIA treatement
Lifestyle modification - hyprcholesterolaemia - hypertension Aspirin 300mg Surgical - carotid artery disease
What is a stroke
Sudden onset focal neurological deficit lasting more than 24 hours or with imaging evidence of brain damage due to either infarction or haemorrhage
Emergency treatment of stroke
Thrombolysis for cerebral infarct/ acute ischaemic stroke symptoms - alteplase
Anticoagulation reversal / selective neurosurgical intervention for intracranial bleeds - aspirin
Types of strokes
Total anterior circulation stroke (TACS) - worst prognosis
Partial anterior circulation stroke (PACS)
Lacunar stroke (LAC)
Posterior circulation stroke (POCS)
Checks to certify death
Pupils fixed and dilater
No response to pain
No breath or heart sounds after 1 min ausculation
Features of death certificate
1a - cause of death
1b - condition leading to cause of death
1c - additional condition leading to 1b
2 - any contributing factors or conditions
