W8 - Older Adults

Question 1

Whats the difference between acute confusional state and dementia

Answer 1

Acute confusional state - delirium
Chronic/over a period of time - dementia

Question 2

RIsk factors of delirium? (6)

Answer 2

1. Sleep deprivation
2. Impaired sensory functioning and sensory deprivation (not getting enough sensory stimulation
3. Bedbound - eg fractures or smt that keeps them in bed
4. Transfer to an unfamiliar location
5. Stress
6. Drug to drug interactions

Question 3

Management of delirium?

Answer 3

1. Admit to hospital
2. Diagnostic tests to identify treatable & reversible causes
   - full recovery expected for delirium with normal brain
   - return to premorbid state for delirium with previously undiagnosed early dementia
   - treat delirium with established dementia early to prevent further mental function decline
3. Appropriate specific treatment
4. Quality care for speedy recovery - hydration, nutrition, bladder & speedier recovery, no restraints used, bedsore prevention, bladder & bowel care
5. Quiet env with good lighting, warm & reassuring staff
6. Sedatives must be used with caution

Question 4

Whats dementia?

Answer 4

• illness that causes brain cells to die at a faster rate than normal
• not a normal part of ageing
• mental abilities declines -> failing memory, poor intellectual function & personality changes
• risk of dementia increases with age

Question 5

Who are at risk for dementia?

Answer 5

1 Older age
2 Genetics
3 Females: live longer than males
4 Lack of education
5 Head injury
6 Smoking, alcohol
7 Diabetes, stroke, hypertension, hyperlipidemia, obesity, stroke, depression
8 Social isolation

Question 6

What are the behavioural & psychological classifications of dementia?

Answer 6

Behavioural:
1. Aggression
2. Wandering
3. Sleep disturbance
4. Inappropriate eating behaviour
5. Constant questioning
6. Shadowing: Follow their caregiver around bcs they feel like they need to
7. Negativism: Refusal to comply with requests

Psychological:
1. Hallucinations
2. (Paranoid) Delusions
3. Depression
4. Apathy
5. Anxiety
6. Misidentification

Question 7

Pharmacological Treatment for Dementia?

Answer 7

1. Acetylcholinesterase inhibitors
   - egs: donepezil, rivastigmine, galantamine
   - side effects: nausea, vomiting, agitation, giddiness, bradycardia
2. NMDA antagonist
   - memantine
   - side effects: giddiness, nausea, vomiting
3. Antipsychotics
   - risperidone, olanzepine, quetiapine, haloperidol
   - side effects: anticholinergic effects, extrapyramidal side-effects
4. Antidepressants
   - fluvoxamine, escitalopram, mirtazepine
   - side effects: anticholinergic effects, hypotension
5. Mood stabilisers:
   - sodium valproate, lithium
   - side effects: thromocytopenia
6. Benzodiazepines:
   - lorazepam, clonazepam
   - side effects: hypotension, sedation

Question 8

Pharmacological Treatment for Depression?

Answer 8

1.SSRIs used as first line
- safe & overdose free
- fewer anticholinergic side effects
- egs: fluoxetin, fluoxamine, escitalopram, setraline

2. Tricyclic antidepresssants
   - if they are resistant to SSRIs
   - can cause cardiac arrythmia for elderly
   - egs: imipramine, amitriptyline, nortriptyline
3. MAO inhibitors
   - egs: phenelzine, trancylopramine
4. Other psychotropic agents
   - Benzodiazepines: lorazepam, clonazepam
   - Antipsychotics: risperidone, olanzepine, quetiapine
   - Mood stabilisers: sodium valproate, lithium