Orthogeriatric's, Dementia and Delirium, Frailty

Question 1

What are the 4 A’s in the 4AT test?

Answer 1

1) Alertness
2) AMT 4
3) Attention
4) Acute change/fluctuating course

Question 2

What are the 2 main managements for Osteoporosis?

Answer 2

1) Primary prevention (FRAX)
2) Secondary Prevention:
a) Pharmacological: Calcium/Vit. D replacement, Bisphosphonates
b) Non-Pharmacological: Weight bearing exercises, Muscle strengthening, Falls prevention, Smoking cessation and alcohol avoidance

Question 3

What are the important considerations in planning for the future? (PFF)

Answer 3

1) Advanced care planning
2) Identification of end of life
3) Palliative care (Where and when)

Question 4

Define Delirium

Answer 4

Acute confusional state fluctuating in severity and normally reversible

Question 5

Define Dementia

Answer 5

Syndrome of acquired, chronic, global impairment of higher brain function in alert patient affecting daily function and living

Question 6

What is Hyperactive Delirium?

Answer 6

Delirium with increased physical symptoms e.g. agitation, restlessness, wandering

Question 7

What is the first line treatment for Hyperactive Delirium?

Answer 7

1) Non-Pharmacological: Orientation, reassurance, continuity, provide hearing aids/glasses
2)

Question 8

What are the main symptoms of Hypoactive Delirium?

Answer 8

Lethargy, slowness with everyday tasks, excessive sleeping, inattention

Question 9

What is BPSD?

Answer 9

Behavioural and Psychological Symptoms of Delirium until proven otherwise
(Heterogenous group of non-cognitive symptoms and behaviours)

Question 10

What are the 2 main scoring systems of Frailty?

Answer 10

1) Phenotype (Fried)
2) Cumulative Deficit e.g. Rockwood, e-FI, CFS

Question 11

What is the Fried criteria?

Answer 11

Description of Phenotype (Observable Characteristics) defining frailty as a clinical syndrome with self-reported exhaustion, unintentional wt. loss etc
- Independently predictive of falls, worsening mobility, ADL disability

Question 12

What does the e-FI3 score include?

Answer 12

Robust predictive validity for outcomes of 1, 3 and 5 year mortality, hospitalisation and nursing home admission

Question 13

What elements are included in advanced care planning? (ACP)

Answer 13

• Legal aspects (DoLs, LPoA)
• Preferred place of care
• Treatment options available and suitable for patient
• DNACPR
• Plan for complex scenarios

Question 14

What are some of the key features of Delirium?

Answer 14

1) Abrupt Onset
2) Change in cognition: Hallucination, Illusion, Delusion
3) Fluctuating (Change in day e.g. Sun-Downing)
4) Inattention/distractible

Question 15

What are the 3 tools for Delirium diagnosis?

Answer 15

1) CAM
2) 4AT
3) DSM-5

Question 16

What is the most common subtype of Delirium?

Answer 16

Hypoactive (Main symptoms: Drowsy, stay in bed, don’t cause chaos, –> Risk of pressure sores, dehydration and drowning)

Question 17

What one of the chronic problems of Delirium?

Answer 17

8x more likely to develop dementia

Question 18

What is the mnemonic to remember Delirium?

Answer 18

PINCHME
Pain, Infection, Nutrition, Constipation, Hydration, Medication, Environment (Plus Bladder)

Question 19

What are some of the main triggers of Delirium?

Answer 19

1) Acute Medical Illness (Infections, Hypoxia, Thyroid etc)
2) Environment e.g. Sleep, Procedures, Catheters/Cannulas
3) Drug Side effects e.g. Opioids, Steroids, TCAs, anti-parkinsonian drugs, anticholinergics
4) Pain, Urinary retention, faecal impaction, drug/alcohol withdrawal

Question 20

What is the main method for treatment of Delirium?

Answer 20

1) Correct pre-disposing RF e.g. visual impairment, malnutrition, dehydration
2) Reorientation e.g. Clocks/calendars, reassurance