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The elderly Flashcards

1
Q

What is frailty

A

Reduced ability to withstand illness without loss of function

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2
Q

What is ageing

A

Progressive accumulation of damage to complex system resulting in aggregate loss of system redundancy

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3
Q

What is frailty phenotype?

A 
3 of 5 criteria
Unintentional weight loss
exhaustion
Weak grip strength
Slow walking speed
Low physical activity
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4
Q

What is HIS think frailty?

A 
Functional impairment 
Resident in care home
Acute confusion
Immobility or falls
List of 6+ medicines
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5
Q

What are examples of health domains?

A 
Medical
Psychological
Functional
Behavioural
Nutritional 
Spiritual 
Social
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6
Q

What is a comprehensive geriatric assessment

A

Process to assess and manage illness in older people with frailty

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7
Q

What are key features of delirium?

A

Disturbed consciousness
Change in cognition
Acute onset and fluctuant

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8
Q

What are the consequences of delirium?

A

Increased risk of death, longer stay, increased institutionalisation, persistent functional problems

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9
Q

What precipitates delirium?

A 
Infection
Dehydration
Biochemical disturbance
Pain
Drugs
Constipation/retention
Hypoxia
Alcohol/drug withdrawal
Sleep disturbance
Brain injury
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10
Q

How to treat delerium

A 
Treat cause
Stop bad drugs
Usually no need for drug treatment of delirium 
Re-orientate and reassure agitated patients 
Correction of sensory impairment
Normalise sleep-wake cycle
Ensure continuity of care
Avoid catheterisation/venflons
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11
Q

What is dementia

A

Acquired decline in memory and other cognitive functions in an alert person sufficiently severe to cause function impairment and present for more than 6 months

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12
Q

Alzheimers features

A

Slow insidious onset
Loss of recent memory first
Progressive functional decline
RFs - age, vascular risk factors, genetics

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13
Q

Vascular dementia features

A

Step wise progression
Executive dysfunction may predominate
Gait problems
Often known vascular risk factors

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14
Q

Dementia with Lewy Bodies features

A

Link with parkinson’s
Very fluctuant
Hallucinations common
Falls common

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15
Q

Reversible causes of dementia

A 
Hypothyroidism
Intracerebral bleed/tumours
B12 deficiency
Hypercalcaemia
Normal pressure hydrocephalus
Depression
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16
Q

Fronto-temporal dementia features

A

Onset at earlier age
Early symptoms different - behavioural change, language difficulties, memory early on not affected
Lack insight into difficulties

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17
Q

Management of dementia

A 
Support for person and carers
Cognitive stimulation
Exercise
Music/light therapy
Cholinesterase inhibitors 
Antipsychotics - avoid if possible, start low go slow
18
Q

What is capacity/

A

Is patient capable of making decisions about their care
Do they have a legally appointed proxy decision maker
Do we/relatives know what their wishes would be

19
Q

Why do patients fall?

A

Intrinsic factors - Gait and balance problems, syncope, chronic disease, visual problems, acute illness,
Extrinsic factors - environmental hazards, poor lighting
Situational factors - medications, alcohol, urgency of micturition

20
Q

Assessment of gait and balance

A 
Sitting to standing ability
Transfers
Static standing balance
Romberg test
Dynamic standing balance
Gait
21
Q

Causes of syncope

A

Situation syncope - acute haemorrhage, cough/sneeze, GI stimulation, micturition, post exercise
Orthostatic hypotension - autonomic failure, volume depletion (haemorrhage, diarrhoea, addison’s)
Cardiac arrhythmias - sinus node dysfunction, AV conduction disease, implanted device malfunction
Structural cardiac or cardiopulmonary disease
Cerebrovacular

22
Q

Question in a history assessing syncope?

A

Patient - Prodromal symptoms, loss of consciousness, last and first things they recall, previous episodes, injuries, PMH, FH, medications
Collateral - Circumstances of event, posture before LOC, appearance, movement?, tongue biting, Duration of event, confusion?, weakness?

23
Q

Examination in assessing syncope?

A

Vital signs - lying and standing blood pressure
Focussed neurological and cardio exam
Look for injuries

24
Q

Features of 12 lead ECG in syncope assessment?

A

Inappropriate, persistant bradycardia, Long QT, Abnormal T wave inversion

25
Q

Red flags for syncope

A 
ECG abnormality
Heart failure
Onset with exertion
FH of sudden cardiac death/inherited cardiac condition
New or unexplained dyspnoea
Heart murmur
26
Q

Features of a seizure

A

Seizure if 1 or more of
Bitten tongue, head to 1 side, no memory, unusual posturing, prolonged jerking, confusion
And not
prodromal symptoms, sweating, precipitated by prolonged standing, pallor during episode

27
Q

Causes of sarcopenia

A 
Diabetes
Elderly
Chronic disease
Lack of use
Inflammation
Nutritional deficit
Endocrine
28
Q

Effect of absorption of levodopa in elderly

A

Increased

29
Q

Body composition changes in elderly

A

Reduced muscle mass
Increased adipose tissue
reduced body water

30
Q

Effect of body composition changes on drug distribution i

A

Fat soluble drugs have increased distribution (diazepam, haloperidol)
Water soluble drugs have decreased distribution, therefore increased serum levels (digoxin, atenolol, theophylline)

31
Q

Protein binding changes in elderly

A

Decreased albumin there for decreased binding and increased serum levels of acidic drugs

32
Q

Opioids in elderly

A

Lower doses needed

33
Q

NSAIDs in elderly

A

Increased adverse effects
renal impairment
GI bleeding

34
Q

Digoxin in elderly

A

Increased toxicity

Lower doses need

35
Q

Diuretics in elderly

A

Reduced clearance

36
Q

Antihypertensives in elderly

A

Exaggerated effects on BP and HR
More likely issues with postural hypotension
ACEi often pro-drugs not metabolised to active form
Renal adverse effects

37
Q

Anticoagulants in elderly

A

More sensitive to warfarin

greater risk from warfarin

38
Q

Antibiotics in elderly

A

Increased adverse effects

39
Q

Excretion in age

A

Renal function decreases

Reduced clearance, increases half life of many drugs

40
Q

Pharmacodynamics in elderly

A

Increased sensitivity to particular medicines

DIazepam, warfarin

41
Q

Metabolism in elderly

A

Toxicity due to reduced metabolism

Reduced first pass metabolism

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