Perspectives on ageing 2 Flashcards
What is frailty?
Physiological syndrome characterised by decreased reserve and less resistance to stressors resulting from cumulative decline across multiple systems – increased risk of adverse outcome
What are the causes and outcomes of frailty?
Genetic – cumulative cellular damage (reduced physiological reserve)
LARGE ROLE OF NUTRITION AND PHYSICAL ACTIVITY
Stressor events in frail people can lead to falls, delirium and fluctuating disability (geriatric syndromes)
Poor outcomes – sub-optimal recovery (vulnerable)
What are the ‘geriatric giants’?
Falls Reduced mobility Confusion Weight loss Not coping Iatrogenic harm
What are some example condition where the presentation is different for older patients?
Acute coronary syndrome – less likely to have chest pain, more likely to have shortness of breath
PE – Less likely to have pleuritic chest pain or haemoptysis, more likely to have syncope
What are the problems associated with multi-morbidity?
Conditions impact on one another Treatments may impact on one another Worse QoL Increased functional impairment Burden of treatment
What are the problems associated with polypharmacy?
Higher chances of interaction between medication
Following guidelines too closely – tests were done on younger people
Undetected non-adherence
Infrequent review
Poor communication
Prescribing cascades
What is potentially inappropriate prescribing?
Potentially inappropriate prescribing (PIP) - unneeded and often not the most effect prescription
Up to 40% prescriptions PIPs
Associated with bad outcomes
17% admissions due to drug reactions
What generalised assessment can be used to improve outcomes in older people?
Comprehensive geriatric assessment CGA – multidimensional interdisciplinary assessment for individualised plan. Needs time and expertise from MDT
CGA increase likelihood of being alive and in own home up to 12 months after admission
CGA in community reduce admissions to institutional care
What are the domains of the CGA?
Physical health Mental health Functional ability Social circumstances Environment
Briefly describe rehabilitation
Restore function
Requires MDT
Prevent deconditioning
Prehabilition – e.g. optimise before operation
What physical and functional changes are observed in the ageing brain/
Atrophy
Cerebral vascular disease
Physiological – processing speed slow, working memory reduced, reduced DIVIDED attention, executive functions generally reduced
No change in declarative memory or visuospatial brain or language (coherence may be reduced)
What questions should be asked when a patient presents with confusion?
Are they actually confused (Hearing problems etc often mistaken for confusion)
Delirium or dementia
What is dementia?
Consciousness not impaired
Cognition progressing decline (all domains)
Lack of insight
Dementia causes – Mostly Alzheimer’s Disease, then vascular dementia
What is delirium?
Acute fluctuating global failure (consciousness and cognition)
ACUTE BRAIN FAILURE
NEWS 2 – includes delirium
Lasts hours to days but is reversable
What is tested in the 4AT cognitive exam?
4AT (Alertness, AMT 4, Attention, Acute changes or fluctuating course >4 = delirium, 1-3 possible cog impairment 0=impairment unlikely)
