Older Persons Care

Question 1

Medication that is safe to use in the Elderly for depression?

Answer 1

Mirtazapine

Question 2

What are the 5 frailty syndromes

Answer 2

-Confusion
-Susceptibility to medication side effects
-reduced mobility
-Urinary Incontinence
-Delerium

Question 3

What is delirium?

Answer 3

it is the worsening of an individuals mental state over a period of time resulting in symptoms such as drowsiness, disorientation and sometimes even hallucinations

Question 4

List the 9 contributing factors to falls in the elderly?

Answer 4

-Sedation
-hypotension
-Hypoglycaemia
-Dizziness
-Vision Impairment
-Dehydration
-Urinary Incontinence/Retention
-Medication Challenges
-Confusion/delerium

Question 5

Define Frailty?

Answer 5

is the age-associated decline in physiological reserve and function across multi organ systems leading to increased vulnerability to adverse health outcomes

minor event can lead to a major change making it difficult to return to previous level of health

Question 6

How to assess frailty?

Answer 6

-electronic frailty index
-Rockwood Frailty Score
-PRISMA 7 questionnaire
-Gait speed
Time up and go test

Question 7

Drugs to avoid in postural hypotension?

Answer 7

CCB, alpha blockers, SNRIs, levadopa

Question 8

Management of postural hypotension in the elderly?

Answer 8

Midodrine and fludicortisone ( don’t give in patients with AF)

Question 9

Management of Dizziness?

Answer 9

avoid benzodiazepines ( generally any type of sedating drug

switch from a sedating to non-sedating antihistamine

Question 10

Management of Vision Impairement?

Answer 10

Deprescribe anti-cholinergic medications and alpha/beta blockers

Question 11

Management of hypoglycaemia?

Answer 11

Review oral anti-diabetics
Avoid pioglitazone  risk of fractures, heart failure, bladder cancer
Avoid starting sulphonylureas in elderly/review existing prescriptions e.g tolbutamide, glicazide, glipezide

SGLT-2 inhibitors and DPP4 inhibitors may be used as 2nd line therapy

Question 12

Drugs not suitable in urinary incontinence?

Answer 12

Bladder antimuscarnics e.g. oxybutynin, solifenacin, tolterodine (not suitable for older patients due to high anti-choleringeic burden

Question 13

Suitable drug to treat urinary incontinence in the elderly?

Answer 13

Mirabegron

also NICE suggests bladder training, and pelvic floor excersises

Question 14

Emergency urinary retention treatment?

Answer 14

catherisation

Question 15

What are the three classes of drugs which have the most leading cause of falls?

Answer 15

-psychotropic drugs
-drugs acting on the heart and blood circulation
-drugs affecting blood sugar levels