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OPIC > Older persons medicine lecture > Flashcards

Older persons medicine lecture Flashcards

1
Q

What is carer strain?

A
  • When family member cares for another family member and this becomes overwhelming leading to stress, depression and ill physical health
  • Often as private care is expensive
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2
Q

Falls history

A
  • When and where
  • Frequency, time course - how many falls within last 12 months?
  • What was the patient doing just before? - change of posture? head movement/bending? turning?
  • What happened after?
  • Get witness report - ask
  • Be cautious with ‘I tripped’ and ‘blackout’
  • If fall in toilet at night - often due to postural drop
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3
Q

Red flags for falls

A
  • Loss of consciousness
  • New confusion
  • Trauma to head
  • Vomitting
  • Incontinence
  • Seizure activity
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4
Q

Definition of recurrent falls

A

More than 2 within last 12 months

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5
Q

If someone does not lose consciousness, how do they fall?

A

Have protective mechanism - reach out arms eg wounds on hands
Those who don’t - just hit the ground, could have nose fracture or head wound

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6
Q

Who can you contact for urgent review of home for falls risk?

A
  • Intensive community support team
  • Have OT, physio and nurses - assess and prevent admission
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7
Q

Financial threshold for carers being funded?

A

If you have £25,000 of savings - you will have to pay for carers
Below this they are government funded

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8
Q

Inv for falls

A
  • Look for injuries - body map, WHOLE body
  • ECG
  • Lying and standing BP
  • Medication review - polypharmacy = 5 and above
  • Gait/functional assessment
  • Bone health review
  • Fear of falling/loss of confidence
  • Exercise program - strengthen muscles and teach how to fall

If on 3 or more BP tabs, do they have compliant issues?

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9
Q

Key components of CGA

A
  • Medical - problem, co-morbids, meds, nutrition
  • Functional - activities of daily living, gait and balance, exercise
  • Psycological - cognitive status, mood
  • Social - informal social support?
  • Environmental - home safety, care resource eligibility, access to transport

If change in environment occurs, can make changes in elderly more obviou

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10
Q

Clinical frailty score

A

If 6 and above - see by geriatrician for advanced care planning and review

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11
Q

When is POA valid?

A

When someone is determined to have lost their capacity
Otherwise they make the decision themselves
(originally signed when has capacity with solicitor)

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12
Q

What does someone have to lack to be deemed lacking capacity?

A

They will lack the ability to:
* Understand information given about specific decision
* Retain information long enough to make decision
* Weight up information
* Communicate decision

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13
Q

Capacity can be…

A
  • Fluctuant
  • Decision specific for that decision alone at that point of time
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14
Q

Safeguarding - what is it

A
  • Measures to protect health, wellbeing and human rights of individuals
  • Allows people - esp children, young people and vulnerable adults to live free from abuse, harm and neglect
  • Concerns can be raised to either local safeguard team or social services
  • If crime been comitted may need police input
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15
Q

Types of fluids and foods - SALT

A
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16
Q

What is feed at risk?

A
  • Person continues to eat and drink despite significant risk of aspiration/choking
  • Ensures QOL - highest priority
  • Allows continued enjoyment, comfort, pleasure and social interaction
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17
Q

When is feed at risk more appropriate?

A
  • Advanced stage of illness
  • Swallow safety not likely to improve
  • Preference is to eat and drink over swallow safety
  • Tube feeding is declined/inappropriate
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18
Q

What can you do if you are concerned about a patient at home who does not need acute hospital admission but cannot cope at home alone?

A
  • Community hopsital admission can be considered
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19
Q

What is DTA bed? - discharge to assess

A
  • Bed in care home
  • Funded by council - first 4-6 weeks
  • Then observed by community team - will have MDT whether need care home or can go home
  • If need to be care home - will assess funding needs
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20
Q

Nursing home vs residential home

A
  • Nursing home - staffed by nurses, eg if PEG feed needs, advanced dementia, more expensive
  • Residential home - staff are trained but not in nursing care
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21
Q

Referral for ?dementia

A

Memory clinic

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22
Q

Prognosis if needing to be admitted to nursing home

A

18 months - 2 years

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23
Q

Tips for OSCE

A
  • Use every second - write down differentials at start and structure
  • Make sure ask about differentials specifically to eliminate them - eg if suspect PE - ask about haemoptysis, stroke ask about weakness
  • Every sentence means something in the exam
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24
Q

What medication in elderly can cause GI bleed?

A

Sertraline

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25
Q

What is the definition os postural drop?

A
  • Reduction in 20mmHg systolic or more on standing
  • Or reduction in 10 mmHg diastolic or more
  • Should also check have symptoms to diagnose
26
Q

How to perform lying and standing BP?

A
  • Lie down flat for 5 minutes - measure
  • Stand up - feel ok?
  • Measure BP 1 minute after standing
27
Q

What should yoiu encourage when in hospital?

A
  • Independence
  • Own routine
  • Can encourage wearing of own clothes - look a lot more well
28
Q

What is medication for postural drop?

A
  • Fludrocortisone - increases BP, is a mineralocorticoid so increases fluid retention
  • CAUTION in HF - can cause pulmonary oedema (will cancel out furosemide)
29
Q

Prescribing medications in elderly

A
  • Caution when over 5 meds
  • Consider removing a medication if a new one is needed
  • Use STOPP/START
  • Start low and go slow
30
Q

Most useful inv for incontinence

A

Post void bladder scan - check for overflow incont

31
Q

When to refer to cystoscopy?

A
  • Painless haematuria
32
Q

When is urine dipstick useful in elderly?

A
  • For haematuria and proteinuria
  • Not useful for infection
33
Q

Continence assessment inv

A
  • Detailed history
  • Bladder and bowel diary
  • Abdo exam
  • Urine dip and MSU
  • PR exam inc prostate assessment in male
  • External genitalia review - look for atrophic vaginitis in females
  • Post micturition bladder scan
34
Q

How much sirloin steak (250g) of muscle mass do people lose if people bed bound for 1 week?

A

Lose one sirloin steak every day
= 6 steaks (ish) per week

35
Q

Management of incontinence

A
  • Decaff drinks
  • Good bowel habits
  • Improve oral intake - but stop drinks 4 hrs before bed time
  • Regular toileting
  • Pelvic floor exercises and bladder training
  • Anticholingerics not good in elderly (esp oxybutynin)
  • Postural drop can occur from drugs used for incontinence
  • Drug therapy and pads are NOT first line
36
Q

Anticholinergic side efefct

A
  • Dry mouth
  • Dry eyes
  • Blurred vision
  • Confusion
  • Urinary retention
37
Q

Fragility fracture define

A
  • Fracture from falling from standing height or lower at walking speed or slower
  • Occur most in spine (vertebrae), hip (proximal femur) and wrist (distal radius)
38
Q

Seeing fragility fracture on x-ray vs pathological fracture

A
  • May be evidence of osteoporosis - lucent areas within bone, transparent
  • Pathological fracture - lucency with blurry margin and dense white colour
39
Q

OP bloods

A

Normal

40
Q

When to assess OP of patients and how?

A
  • All women aged 65 years and over
  • All men aged 75 and over

If under these ages with RF below, investigate with FRAX:
* previous fragility fracture
* current use or frequent recent use of oral or systemic glucocorticoids
* history of falls
* family history of hip fracture
* other causes of secondary osteoporosis
* low body mass index (BMI) (less than 18.5kg/m2)
* smoking
* alcohol intake of more than 14units per week for women and more than 21units per week for men

41
Q

FRAX score and management

A
  • Green - lifestyle advice and reassure, reasses 5 years- exercise, balanced diet
  • Amber - DEXA scan to check BMD, recalculate risk
  • Red - give bisphosphonate straight away
42
Q

Management of OP - medicine

FINSISH

A
  • Check vitamin D, calcium level and renal function first (>30)
  • Bisphosophate (oral) - alendronic acid
  • Takes 6-12 months to work
  • Warn re osteonecrosis of jaw - rare

Bisphosphonate will lower calcium so check!!!

43
Q

Hypocalcaemia symptoms

A
  • Tingling
  • Muscle spasms
  • Tetany
  • Cardiac arrhythmia - prolonged QT
44
Q

How to advise someone to take alendronic acid

A
  • Take first thing in the morning - on empty stomach (compete for protein receptors)
  • Sit upright and no food for 30 minutes
  • With large glass of water - due to risk of oesophagitis and perforation
45
Q

Alternative options if someone will find oral bisphosphonate difficult (eg if vomitting, GI ulcers or cognitive impairment)

A
  • IV zolendronate
  • One off per year - 30 minute
  • Ensure calcium, vitamin D and renal function ok
  • Check teeth post infusion –> dentist review?
46
Q

Alternative to bisphosphonate if CrCl <35 or eGFR low <30 or if intolerant to IV and oral bisphosphonates

A
  • Denosumab
  • MAB
  • Inhibits osteoclasts, decreases bone resorption, increases BMD
  • SC injection once every 6 months
  • Risk of ONJ and stress fractures
47
Q

When not to operate on hip fracture?

A
  • Rarely not operate - only if dying
  • Outcomes are better earlier on
  • If infection, give 48hrs abx then operate
  • If have hip fracture - it is a prognostic sign, 50% die within nect year
48
Q

Why operate on hip fracture?

A
  • Ensure pain control
  • Reduce opioid requirements
  • Allow good nursing care
  • Allow sitting out
  • Allow chance to regain function
49
Q

NICE guidelines of CT head scan following head injury

A
50
Q

Causes of delirium

A

THINK DELIRIUM
* Trauma
* Hypoxia (PE, CCF, MI)
* Increasing age
* Neck femur fracture
* SmoKe or alcohol withdrawal
* Drugs stopped
* Environment - ward moves
* Lack sleep
* Imbalanced electrolytes
* Retention - urinary or constipation
* Infection/sepsis
* Uncontrolled pain
* Medical conditons - delirium, parkinsons

51
Q

Management of dementia reduced feeding and weight loss

A
  • Hand feed blended normal foods
  • Not suitable for PEG
52
Q

Asisstance for feeding in hospital

A

Red tray/red lid to jug

53
Q

MUST score

A
54
Q

Which delirum more concerning?

A

Hypoactive - longer hosp stay, higher mortality and morbidity rate

55
Q

Common areas for pressure sores

A
  • Sacrum
  • Heels
  • Elbows
  • Ears
56
Q

RF for pressure sores

A

Waterlow
* Low BMI
* Broken skin/oedematous
* Older
* Losing weight
* Incontinence problem
* Co-morbidities

57
Q

Grading of pressure sores

A
58
Q

Management of pressure sore

A
  • Prevention
  • Wound management - dressing changes, manage pain
  • Friction reduction
  • Nutrition - protein to speed up healing
  • Pressure redistribution and repositioning
59
Q

If someone does not have capacity, what is DOLS?

A
  • Deprivation of liberty safeguards
  • Legal document
  • Allows clinicans to make decisions in patients best interest
60
Q

Dishcarge destinations for patients

A
  • Own home (+POC)
  • Community hospital
  • Specialist accomodation (Warden control) - warden can come and help if necessary, independent
  • Discharge to assessment bed - if max POC and may need care home
  • Residential home
  • Nursing home - if need more nursing needs eg PEG tube, catheter, parkinsons
  • Fast track - life expectancy less than 6 weeks
61
Q
A

OPIC (17 decks)

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