Pathology of Ageing + Comprehensive Geriatric Assessment Flashcards
What is fundamental of geriatrics (frailty NOT age)
- Routine investigations
Treat any infection - urine / CXR / ECG (routine) Stop drugs Fluid Bowel - PR Mobility Nutrition
Why are people getting older
LE rising and fertility falling Increased resources Better economic conditions Improved screening tests Better outcomes following major events
What are the theories of ageing
Stochastic - cumulative / random damage
Programmed
Homeostasis failure
What does ageing do to the kidney
GFR decreases
Why does creatinine levels stay the same as we age
Because we lose muscle mass so less creatinine produced but clearance has decreased
What happens to systolic, diastolic and CO
Systolic increases
Diastolic decreases
CO decreases
What is the importance of diastolic pressure
It is what keeps you upright so if BP low then you prevent stroke but more likely falls and fracture
What happens to TLC and VC
TLC stays the same
VC decreases
What is the body’s response to cold stress in frailty
Reduced vasoconstriction
Reduced metabolism
What is the body’s response to heat stress in frailty
Reduced sweat output
Reduced skin blood flow
Smaller increase in CO
Less redistribution of blood flow from renal and splanchnic
What is Frailty
Progressive dyshomeostasis
Leading to impairment of organ function and increased susceptibility to environmental stress
REDUCED ABILITY TO WITHSTAND ILLNESS WITHOUT LOSS OF FUNCTION
Increased vulnerability
Risk of further deterioration with minimal stress
What are the impacts of ageing / frailty
Social isolation
Higher risk of long term care
Increased co-morbidites and polypharmacy
ADR
Evidence gap in trials for medication
Increased variability in organ function of different people
Disruption in multiple health domains
Different presenting S+S
Dyshomeostasis in one system leads to lots involved
How does hyperthyroid classicaly present
Tremor
Anxiety
Weight loss
Diarrhoea
How does hyperthyroid present in frailty
Depression
Cognitive impairment
Muscle weakness
HF, angina, AF
What are the different health domains (need to deal with all in frailty / CGA
Medical - co-morbid / RV med / problem list / ACP
Psychological - mood / cognition (4AT) / anxieties
Functional - mobility/ ADL
Behavioural - eating / hobbies / job / smoking
Nutritional - MUST
Spiritual
Environmental - housing / heating / telehealth / transport
Social - support / abuse
Societal
How do we identify someone as frail?
Frailty index - disease state, abnormal lab result, S+S, disability
Fried et al Frailty phenotype 3/5
Frailty syndromes
Ilness Trajectory - gradual decline, crisis = admission, improve but not to baseline
What are frailty syndromes (what most people present to hospiptal with)
Falls Immboility 'off-legs' Functional loss Delerium Sarcopenia
What are the fried et al frailty phenotype
3/5 Unintentional weight loss Exhaustion Weak grip strength Slow walk <0.8m/s Low physical activity - timed up and go <12s
What MDT are involved in care of frail people
Geriatician OT PT Nurses GP Social work Home care Dietitian SALT
What is the comprehensive Geriatric assessment
Process to assess and manage illness in older people with frailty
What does the comprehensive geriatric assessment involve
Determine problems What health domains are affected Determine what can be made better Produce management plan Person / goal centred NOT problem centered - preserve autonomy
Where can comprehensive geriatric assessment be carried out
Inpatient
Intermediate care
Home
What does geriatric care require
Early identification of need
Early GCA
Early provision of care
What is the evidence of GCA
The earlier a CGA is carried out in illness of a frail person the better the outcomes Reduced readmission Reduced functional decline + mortality Reduced need for long-term care Greater satisfaction
When do you discharge someone
When goals are met OR when risks > benefit
What are the benefits of hospital
Expertise
Tests and interventions
Rapid support
What are the risks of hospital
Delerium Learned dependency Deconditioning Iatrogenic harm HAI
What are the benefits of identifying frail
Know who is at risk of unstable / adverse outcomes Know who needs CGA Anticipatory care planning Address polypharmacy Reduce social isolation
What is an anticipatory care plan
Plan to be put in place for symptom relief / treatment for patient
What do all frail people need
GCA
What is sarcopenia
Degenerative loss of muscle mass
What are RF for sarcopenia
DECLINE Diabetes Elderly Chronic disease Lack of use Inflammation Nutrition Endocrine
What are common presentations of the elderly
Incontinence Instability / off leg Immobility Delerium / dementia Iatrogenic e.g. drug
What are good systems review after a fall
Any fever Bowels Incontinecne Any swallow problems - Micro-aspirate if LRTI Recent weight loss More forgetful Mood
When would you refer geriatrics vs specific speciality
If lots of comorbid
If particular issue Parkinson then refer neuro
What score for frailiy
Rockwood score
Gives expected life expectancy
What should you use in CKD
Renal drug handbook when prescribing
What does GCA involve
List of issues and plan Physical assessment Socio-economic / environment Functional Mobility / balance Mental Med review
Additional
Key safe
Alarm
Dosset box
