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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 and management general

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 - ask about this
  • 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
  • Psychological - 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
What is the definition os postural drop?
* Reduction in 20mmHg systolic or more on standing * Or reduction in 10 mmHg diastolic or more * Should also check have symptoms to diagnose
26
How to perform lying and standing BP?
* Lie down flat for 5 minutes - measure * Stand up - feel ok? * Measure BP 1 minute after standing Measure at 3 mins after standing
27
What should yoiu encourage when in hospital?
* Independence * Own routine * Can encourage wearing of own clothes - look a lot more well
28
What is medication for postural drop?
* Fludrocortisone - increases BP, is a mineralocorticoid so increases fluid retention * CAUTION in HF - can cause pulmonary oedema (will cancel out furosemide)
29
Prescribing medications in elderly
* Caution when over 5 meds * Consider removing a medication if a new one is needed * Use STOPP/START * Start low and go slow
30
Most useful inv for incontinence
Post void bladder scan - check for overflow incont
31
When to refer to cystoscopy?
* Painless haematuria
32
When is urine dipstick useful in elderly?
* For haematuria and proteinuria * Not useful for infection
33
Continence assessment inv
* 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
How much sirloin steak (250g) of muscle mass do people lose if people bed bound for 1 week?
Lose one sirloin steak every day = 6 steaks (ish) per week
35
Management of incontinence
* 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
Anticholinergic side efefct
* Dry mouth * Dry eyes * Blurred vision * Confusion * Urinary retention
37
Fragility fracture define
* 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
Seeing fragility fracture on x-ray vs pathological fracture
* May be evidence of osteoporosis - lucent areas within bone, transparent * Pathological fracture - lucency with blurry margin and dense white colour
39
OP bloods
Normal
40
When to assess OP of patients and how?
* 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 18.5 kg/m2) * smoking * alcohol intake of more than 14 units per week for women and more than 21 units per week for men
41
FRAX score and management
* 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
Management of OP - medicine | FINSISH
* 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
Hypocalcaemia symptoms
* Tingling * Muscle spasms * Tetany * Cardiac arrhythmia - prolonged QT
44
How to advise someone to take alendronic acid
* 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
Alternative options if someone will find oral bisphosphonate difficult (eg if vomitting, GI ulcers or cognitive impairment)
* IV zolendronate * One off per year - 30 minute * Ensure calcium, vitamin D and renal function ok * Check teeth post infusion --> dentist review?
46
Alternative to bisphosphonate if CrCl <35 or eGFR low <30 or if intolerant to IV and oral bisphosphonates
* Denosumab * MAB * Inhibits osteoclasts, decreases bone resorption, increases BMD * SC injection once every 6 months * Risk of ONJ and stress fractures
47
When not to operate on hip fracture?
* 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
Why operate on hip fracture?
* Ensure pain control * Reduce opioid requirements * Allow good nursing care * Allow sitting out * Allow chance to regain function
49
NICE guidelines of CT head scan following head injury
50
Causes of delirium
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
Management of dementia reduced feeding and weight loss
* Hand feed blended normal foods * Not suitable for PEG
52
Asisstance for feeding in hospital
Red tray/red lid to jug
53
MUST score
54
Which delirum more concerning?
Hypoactive - longer hosp stay, higher mortality and morbidity rate
55
Common areas for pressure sores
* Sacrum * Heels * Elbows * Ears
56
RF for pressure sores
Waterlow * Low BMI * Broken skin/oedematous * Older * Losing weight * Incontinence problem * Co-morbidities
57
Grading of pressure sores
58
Management of pressure sore
* Prevention * Wound management - dressing changes, manage pain * Friction reduction * Nutrition - protein to speed up healing * Pressure redistribution and repositioning
59
If someone does not have capacity, what is DOLS?
* Deprivation of liberty safeguards * Legal document * Allows clinicans to make decisions in patients best interest
60
Dishcarge destinations for patients
* 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

OPIC (30 decks)

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