S2 L1 Older People's Health and Dementia

Question 1

What are some changes that occur in the respiratory system during ageing?

Answer 1

• Loss of elasticity so compliance of lung decreases, TLC/FVC/FEV1 all fall

- Atelectasis, PE and pneumonia all common post op conditions in the elderly due to changes in structure. Complications more common in smokers and those with abdominal/thoracic surgery

- Obstructive sleep apnea common as loss of elastic tissue around oropharynx so may collapse in sleep so be carefule with sedative medicatin

Question 2

What are some changes as we age that we need to think about when prescribing drugs to the elderly (pharmacokinetics)?

Answer 2

• Elderly patients have increased sensitivity to CNS depressant drugs so alter dose, e.g benzodiazepenes and opiates

- Reduced hepatic and renal function so slower metabolism of drugs

• Reduced CO so delay in IV anaesthesia and reduced dose needed
• Reduced total body water and increased adipose so changes in volume of distribution of drugs
• Plasma proteins reduced so increased free drug availability

Question 3

What are some changes in the skin as we age?

Answer 3

• Skin thins and loses collage fibres so loss of thermoregulation and elasticity
• Subcutaneous blood tissues fragile so bruise easily and hard to get cannula access

Question 4

What are some changes in the cardiovascular system as we age?

Answer 4

- Decrease in cardiac conducting cells so can get heart block, ectopics, AF etc

• Reduction in CO by 30% due to lack of atrial contraction in AF so 1/3 less ventricle filling

- CO output falls by 3% each year as reduced SV and contractility

• Large and medium vessels less elastic and compliant leading to hypertension which can lead to LV hypertrophy

Question 5

What are some changes in the renal system as we age?

Answer 5

• Glomerulosclerosis
• GFR drops by 1% a year after age 20
• Reduction in CO leads to decline in renal function
• DM, NSAIDs, ACEis, Prostatism and dehydration all common diseases/drugs in elderly that can damage kidneys

Question 6

What are some changes in the CNS as we age?

Answer 6

• Neuronal density reduces
• Cerebral atrophy
• Cerebrovascular disease due to diffuse atherosclerosis and hypertension

Question 7

What are some changes in the endocrine system as we age?

Answer 7

• BMR falls by 1% per year after the age of 30 so reduced muscle mass, impaired thermoregulatory control

Question 8

How can we slow natural cognitive decline? (not caused by underlying disease like dementia)

Answer 8

Question 9

What is dementia and how is it diagnosed?

Answer 9

• A chronic disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning

- Cognitive assessment, blood tests and imaging to rule out other diagnoses

Question 10

What can be some signs of dementia?

Answer 10

• Delay in visual processing
• Difficulty with facial recognition (agnosia)
• Apraxia

NOT JUST ISSUES WITH MEMORY LOSS

Question 11

What is malnutrition and how can we screen for it in the UK?

Answer 11

Any condition caused by an imbalance in what an individual eats and what the individual requires to maintain health (can be over and under nutrition)

Question 12

Why is it important to consider malnutrition in the elderly?

Answer 12

• Will have longer hospital admissions
• Respond less well to treatment and 3 times more likely to develop complications following surgery

Question 13

What are the different types of dementia and what parts of the brain do they affect?

Answer 13

- Alzheimers: hippocampus so memory

- Frontotemporal: frontal and temporal lobe

- Vascular: widespread infarcts over the brain affecting white matter

- Lewy Body: substantia nigra in the mid brain leading to Parkinsons

Question 14

How can we make hospital care less stressful for staff and family of patients with dementia?

Answer 14

• Ask the family if the patient has routines or preferences Share strategies that work with the rest of the team
• If it really is in the patient’s best interest to have care that they do not want get it done as quickly and respectfully as is possible
• Make sure you are continually talking to the patient about what you are doing and why
• Stay calm and engaged with the patient whilst delivering care

Question 15

What are some common causes of malnutrition in the elderly?

Answer 15

• Poor appetite
• Poor dentition or dysphagia
• GI disorders
• Poverty
• Lack of knowledge about cooking or can’t shop
• Physical disability
• Neurological disorders e.g dementia and Parkinson’s

Question 16

What are the five steps of the MUST tool?

Answer 16