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Geriatrics > Pathology of Ageing + Comprehensive Geriatric Assessment > Flashcards

Pathology of Ageing + Comprehensive Geriatric Assessment Flashcards

1
Q

What is fundamental of geriatrics (frailty NOT age)

- Routine investigations

A 
Treat any infection - urine / CXR / ECG (routine) 
Stop drugs 
Fluid 
Bowel - PR 
Mobility
Nutrition
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2
Q

Why are people getting older

A 
LE rising and fertility falling 
Increased resources
Better economic conditions
Improved screening tests
Better outcomes following major events
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3
Q

What are the theories of ageing

A

Stochastic - cumulative / random damage
Programmed
Homeostasis failure

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4
Q

What does ageing do to the kidney

A

GFR decreases

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5
Q

Why does creatinine levels stay the same as we age

A

Because we lose muscle mass so less creatinine produced but clearance has decreased

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6
Q

What happens to systolic, diastolic and CO

A

Systolic increases
Diastolic decreases
CO decreases

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7
Q

What is the importance of diastolic pressure

A

It is what keeps you upright so if BP low then you prevent stroke but more likely falls and fracture

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8
Q

What happens to TLC and VC

A

TLC stays the same

VC decreases

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9
Q

What is the body’s response to cold stress in frailty

A

Reduced vasoconstriction

Reduced metabolism

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10
Q

What is the body’s response to heat stress in frailty

A

Reduced sweat output
Reduced skin blood flow
Smaller increase in CO
Less redistribution of blood flow from renal and splanchnic

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11
Q

What is Frailty

A

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

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12
Q

What are the impacts of ageing / frailty

A

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

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13
Q

How does hyperthyroid classicaly present

A

Tremor
Anxiety
Weight loss
Diarrhoea

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14
Q

How does hyperthyroid present in frailty

A

Depression
Cognitive impairment
Muscle weakness
HF, angina, AF

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15
Q

What are the different health domains (need to deal with all in frailty / CGA

A

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

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16
Q

How do we identify someone as frail?

A

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

17
Q

What are frailty syndromes (what most people present to hospiptal with)

A 
Falls
Immboility 'off-legs'
Functional loss
Delerium 
Sarcopenia
18
Q

What are the fried et al frailty phenotype

A 
3/5
Unintentional weight loss 
Exhaustion
Weak grip strength
Slow walk <0.8m/s
Low physical activity - timed up and go <12s
19
Q

What MDT are involved in care of frail people

A 
Geriatician 
OT
PT
Nurses
GP
Social work
Home care
Dietitian 
SALT
20
Q

What is the comprehensive Geriatric assessment

A

Process to assess and manage illness in older people with frailty

21
Q

What does the comprehensive geriatric assessment involve

A 
Determine problems
What health domains are affected
Determine what can be made better 
Produce management plan
Person / goal centred NOT problem centered - preserve autonomy
22
Q

Where can comprehensive geriatric assessment be carried out

A

Inpatient
Intermediate care
Home

23
Q

What does geriatric care require

A

Early identification of need
Early GCA
Early provision of care

24
Q

What is the evidence of GCA

A 
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
25
Q

When do you discharge someone

A

When goals are met OR when risks > benefit

26
Q

What are the benefits of hospital

A

Expertise
Tests and interventions
Rapid support

27
Q

What are the risks of hospital

A 
Delerium
Learned dependency
Deconditioning
Iatrogenic harm
HAI
28
Q

What are the benefits of identifying frail

A 
Know who is at risk of unstable / adverse outcomes 
Know who needs CGA
Anticipatory care planning 
Address polypharmacy
Reduce social isolation
29
Q

What is an anticipatory care plan

A

Plan to be put in place for symptom relief / treatment for patient

30
Q

What do all frail people need

A

GCA

31
Q

What is sarcopenia

A

Degenerative loss of muscle mass

32
Q

What are RF for sarcopenia

A 
DECLINE
Diabetes
Elderly
Chronic disease
Lack of use
Inflammation
Nutrition
Endocrine
33
Q

What are common presentations of the elderly

A 
Incontinence
Instability / off leg
Immobility 
Delerium / dementia 
Iatrogenic e.g. drug
34
Q

What are good systems review after a fall

A 
Any fever
Bowels 
Incontinecne
Any swallow problems 
- Micro-aspirate if LRTI 
Recent weight loss
More forgetful
Mood
35
Q

When would you refer geriatrics vs specific speciality

A

If lots of comorbid

If particular issue Parkinson then refer neuro

36
Q

What score for frailiy

A

Rockwood score

Gives expected life expectancy

37
Q

What should you use in CKD

A

Renal drug handbook when prescribing

38
Q

What does GCA involve

A 
List of issues and plan
Physical assessment
Socio-economic / environment 
Functional 
Mobility / balance
Mental
Med review
39
Q

Additional

A

Key safe
Alarm
Dosset box

Geriatrics (8 decks)

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