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Y4 OPIC > Older persons medicine > Flashcards

Older persons medicine Flashcards

1
Q

If you can’t get to the toilet upstairs, what can the OT suggest?

A

Glide about commode downstairs

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1
Q

Key elements of the comprehensive geriatric assessment

A
  • Medical assessment
  • Functional assessment
  • Psychologic assessment
  • Social assessment
  • Environmental assessment
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2
Q

What is important to note about capacity?

A

It is decision and time specific
It is fluctuant

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3
Q

What is a DTA bed?

A

A DTA bed refers to a Discharge to Assess bed in healthcare settings, particularly in hospitals or rehabilitation facilities.
First 6 weeks are paid for by the government

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4
Q

What is the main difference between a nursing home and a residential home

A
  • Nursing home is staffed at all times by a nurse
  • Can be up to 2500 a week
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5
Q

Specific side effect of Sertraline?

A

GI bleed

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6
Q

Contra-indication to fludrocortisone

A

Heart failure

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7
Q

Top tips for prescribing

A
  • Is it actually indicated
  • Is the diagnosis correct
  • Are there non-pharmacological alternatives
  • Are the long term benefits tangible
  • Are there any interactions
  • Start low and go slow
  • What is the time frame?
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8
Q

Why do you check vitamin D and calcium before you give bisphosphonates?

A

Optimise first

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9
Q

Requirements for taking bisphosphonates

A

On an empty stomach
Sit up after you take it
Take with a big glass of water- risk of oesophagitis

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10
Q

Specific indication for bisphosphonates

A

Creatinine clearance has to be >35

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11
Q

What medication can you use instead of bisphosphonates

A

Denosumab
Has to be given by specialists

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12
Q

What criteria warrant a head CT within an hour

A

A GCS score of 12 or less on initial assessment
A GCS score of less than 15 at two hours after the injury
Suspected open or depressed skull fracture
Any sign of basal skull fracture
Post-traumatic seizure
Focal neurological deficit
More than one episode of vomiting
Loss of consciousness lasting more than five minutes
Abnormal drowsiness
Dangerous mechanism of injury

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13
Q

Acronym for delirium

A

THINK DELIRIUM

Trauma- head injury
Hypoxia- PE, CCF, MI
Increasing age
Neck of femur
SmoKer
Drugs
Environment
Lack of sleep
Imbalanced
Retentino
Infection
Uncontrolled pain
Medical conditions- dementia, PD

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14
Q

Why must an F1 go to the scanner with a patient with sedation

A

Respiratory depression- respiratory arrest

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15
Q

CT head normal except severe small vessel disease
- Decline in cognition, physical function and swallowing over 6 months and multiple falls.

What is the diagnosis?

A

Vascular dementia

16
Q

Treatment at home for a patient with vascular dementia

A
  • Physio
  • OT
  • SALT
  • Refer to memory clinic
  • Social care
17
Q

Patient with advanced alzheimer’s disease who has stopped eating his meals- what is the option to ensure adequate nutrition?

A

Swallowing has been impaired
Very unlikely the swallowing will get better

Hand feed blended normal foods
Do not recommend artificial feeding- as they will not improve. Different with stroke as they will improve.
At this stage- priority is enjoying the foods they like.

18
Q

Does PEG stop the risk of aspiration?

A

No in advanced dementia, can still aspirate on gastric contents/saliva

19
Q

Is hypo or hyperactive delirium worse?

A

Hypoactive have a longer hospital stay- don’t draw as much attention.
Go unnoticed.

20
Q

Locations for pressure sores to occur

A

Ears- nasal cannula
Sacrum
Heels
Elbow

21
Q

How long does it take to develop a pressure sore?

A

6 hours

22
Q

How are pressure sores graded?

A

Stage 1- non-blanchable erythema- intact skin with redness that doesn’t blanch

Stage 2- partial thickness skin loss- open wound or blister.

Stage 3- Full thickness skin loss- visible fat in wound bed.

Stage 4- full thickness tissue loss- developing muscle, tendon or bone.

23
Q

Management of pressure sores

A
  • Wound management
  • Expensive mats
  • Nutrition
24
Q

Discharge destination

A
  • Own home
  • Community hospital
  • Specialist accommodation (warden control)
  • Discharge to assessment (D2A)- council paid bed in a care home to observe the patient
  • Residential home
  • Nursing home
  • Fast track (end of life care)- preferred place- home, hospice, nursing. Life expectancy is less than 6 weeks (funded by the NHS regardless of money)
25
Q

Services that age UK can offer

A
  • Extended family
  • Practical support at home
  • Day care
  • Dementia support
  • Carers support
  • Befriending
  • Transport
  • Information and advice
26
Q

Additional services that Age UK provide

A
  • Footcare
  • Handyman and gardening
  • Befriending
  • Dementia support service
  • Home care and personal assistants
27
Q

Making a cup of tea assessment for OTs

A
  • Physical demands
  • Attention
  • Memory
  • Further cognitive demands
28
Q

What is the role of an occupational therapist (OT) for elderly patients?

A

In the UK, OTs work within the NHS and social care systems to:

Help elderly individuals maintain independence in daily life.
Support recovery after illnesses or injuries (e.g., stroke, hip fractures).
Prevent hospital admissions by improving safety at home (e.g., reducing falls risks).
Address the psychological impact of physical or cognitive decline.

29
Q

Examples of how an OT modifies the environment

A
  • Calendars, diary
  • Labelling on cupbords, rooms
  • Calendar clock, timers for cooking, alexa
  • Equipment- rails, perching stools, adaptive cuptlery
29
Q

Through what process do OTs assess patients before they leave the hospital to ensure their homes are safe?

A

Discharge to assess

30
Q

How do elderly patients access OT services in the UK?

A
  • NHS referral by a GP
  • Hospital discharge services
  • Local authority or social services
  • Self-referral
  • Charitable support
31
Q

Simple test to assess frailty

A

Timed up and go test
Taking more than 10 seconds to get up from a chair, walk three meters

32
Q

What frailty syndromes would alert you to the fact that a patient is frail?

A

Recognsing frailty syndromes – presence of one or more of these should raise suspicions that the individual has frailty​

Falls​

Immobility ​

Delirium​

Incontinence​

Susceptibility to side effects of medication

33
Q

What are the complications of a an inferior STEMI?

A

AV node heart block
Ventricular arrhythmia (treated with amiodarone)
VT is the most common arrhythmia

34
Q

HbA1c target for management of T2DM with diet and metformin

A

48mmol/mol
(6.5%)

35
Q

HbA1c target for management of T2DM on a hypoglycemic agent

A

53mmol/mol
(7%)

36
Q

What investigations are done for a patient with a stroke under the age of 55?

A
  • Carotid doppler
  • ECG for AF
  • Echo
  • Screening= thrombophilia
  • Bubble echo (to see if there is patent foramen ovale)
  • Autoimmune screen
  • Myeloma screen
  • Viral screen- HIV (IV drug user)
  • Lupus antibody
  • Homocystine level
  • Treponema screen
  • Hep B,C
  • Factor 10 assay

Y4 OPIC (15 decks)

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