Older Persons - Presentations Flashcards
What is syncope?
A transient loss of consciousness (TLoC) due to cerebral hypoperfusion, characterised by rapid onset, short duration, and spontaneous complete recovery.
What are the causes of syncope?
- vasovagal syncope (emotional or orthostatic trigger)
- hypovolaemia
- cardiac arrhythmias
- acute coronary syndrome
- pericardial tamponade
- vascular steal syndrome
- substance abuse
- anxiety
What questions should be asked in TLoC history/
- was loss of consciousness complete?
- how quickly did it come on and how long did it last?
- was there any warning (e.g. light-headedness, nausea, sweating)
- accompanying chest pain or SOB?
- was recovery spontaneous or total?
- has there been a recent change in medication?
How should a patient be examined following a syncopal episode?
- blood pressure (drop of 20mmHg systolic lying»_space; standing = orthostatic hypotension)
- cardiovascular examination
- ECG
- FBC
- random plasma glucose
- respiratory examination
What are some differentials for TLoC?
- syncope
- falls
- epilepsy
- narcolepsy
- dizziness
- TIA / stroke
What are some risk factors for falls?
- age > 80 years
- female gender
- low weight
- previous falls
- dependency in activities of daily living
- orthostatic hypotension
- medication
- diabetes mellitus
- disturbed vision
- cognitive impairment
- gait disorders
- inappropriate footwear
What questions should you ask when doing a falls history?
- was the fall an isolated event?
- what caused the fall?
- what was you doing at the time?
- was there any loss of consciousness?
- was there any warning before the fall?
Following a fall, how should an elderly person be assessed?
- mental state examination
- neurological examination
- visual impairment
- cardiovascular examination
What tests can be used to predict the risk of an elderly person falling?
Timed Up and Go Test (TUGT): patient rises from a chair without support of their arms, walk three meters, turn round and sit again. Completion of the test without unsteadiness suggests a low risk of falling.
Turn 180° test: request the patient stands and steps around until they are facing in the opposite direction. If more than 4 steps are required to do this, it is suggestive of a high risk of falls.
How can falls be prevented?
- home assessment and interventions
- exercise to maintain power and balance
- reduce alcohol intake
- reviewing medications
What is constipation?
Defecation that is infrequent (<3 times weekly), difficult or incomplete.
Presentation of constipation in the elderly.
- confusion or delirium
- nausea
- loss of appetite
- overflow diarrhoea
- urinary retention
What are the risk factors for constipation?
- inadequate dietary fibre
- inadequate fluid intake
- lack of exercise
- anxiety
- drug treatment
Give some causes of constipation.
- low fibre
- elderly age
- post-operative pain
- rectal prolapse
- colorectal carcinoma
- pseudo-obstruction
- hypothyroidism
- opioid analgesics
- spinal nerve injury
How should a patient with constipation be investigated?
- FBCs
- U&Es
- Ca2+
- TFTs
- sigmoidoscopy