Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine block (Y3) > Week 1: Older people (2) (Delirium, dementia, continence, falls, frailty) > Flashcards

Week 1: Older people (2) (Delirium, dementia, continence, falls, frailty) Flashcards

1
Q

define delirium

A

an acute, fluctuating syndrome of disturbed consciousness, attention, cognition and perception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

why is reocngising delirium important

A

Patients who develop delirium also have longer length of stay and more likely to develop hospital acquire complications such as falls and pressure sores

  • Increased mortality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

types of delirium

A
  • Hyperactive – easier to spot
    • Agitated
    • Restless
    • Inappropriate behaviour
  • Hypoactive
    • Lethargy
    • Reduced conc
    • Increased appetite
  • Mixed- hyperactive and hypoactive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

delirium investigations

A
  • Bloods
    • FBC
    • CRP
    • U nd E/cCa2+. LFT, B12/folate, TSH
  • ABG
  • Lumbar puncture
  • Toxicology
  • CT head
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

management of delirium

A
  1. treat underlying cause
    1. environmental
    2. sensory impairment
    3. orientation in place/time
    4. create familiar environment
  2. DoLS/Pharmacological e.g. haloperidol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

pharmacological measures of delirium

A
  • Haloperidol (not to those with parkinsons)
  • diazepam second line
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

presentation of delirium

A
  • Sudden
  • Clouded consciousness
    • Poor attention
  • Fluctuating
  • Symptoms resolve once underlying cause treated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

causes of delirium

A

DELIRIUM

  • Drugs (new stopped /started, side effects, drug interactions)
  • Environment- especially ward moves
  • Lack of sleep
  • Imbalanced electrolytes (renal failure, Na+, Ca2+, glucose, liver function)
  • Retention (urinary and constipation)
  • Infection/sepsis
  • Uncontrolled pain
  • Medial conditions (Dementia, Parkinson’s disease)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

define dementia

A

Dementia is a syndrome (usually progressive) characterised by an appreciable deterioration in cognition resulting in behavioural problems and impairment in the activities of daily living. Decline in cognition is extensive, often affecting multiple domains of intellectual functioning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

types of dementia

A
  • Alzheimer’s most common (50-70%)
    • Women>men
  • Vascular dementia (25%)
  • Lewy body (15%)
  • Frontotemporal dementia
  • AIDS-dementia complex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

alzheimers dementia pathophysiology

A
  • Global atrophy of brain lobes
    • Mostly frontal, parietal and temporal lobes
  • Sulcus widening
  • Enlarged 3rd and 4th interventricular space
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

risk factors for alzheimers

A
  • Head injury
  • High serum cholesterol and fats
  • Lifestyle factors: smoking, midlife obesity and diet high in sat fats
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

alzheimers history

A
  • Ask RF (inc family history of down syndrome)
  • Memory loss  loss of recent first
  • Disorientation to time and place (misplacing items/getting lost)
  • Nominal dysphasia  proper name sand low-frequency words decline first
  • Apathy
  • Decline in ADLs
  • Personality/ mood change
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

management of alzheimers

A
  • Carer support (OT, community services, ID bracelets)
  • Pharmacological
    • Cholinesterase inhibitors
    • Antidepressants
    • Antipsychotics (controversial)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

pharmacological management for people with dementia

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Vascular dementia

Pathophysiology

A
  • Common endpoint of many vascular pathologies intracranially
    • Infarction
    • Leukaoraisois  disease of white matter also called subcortical leukoencephalopathy
    • Haemorrhage
    • Alzheimer’s disease  although not classified as a vascular pathology, AD has a strong vascular risk- factor spectrum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

vascular dementia history

A
  • History of stroke
  • stepwise decline
  • Difficulty solving problems
  • Apathy
  • Disinhibition
  • Slow processing
  • Poor attention
  • Retrieval memory deficit
  • Risk factors similar to IHD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Management of vascular dementia

A

Basically reducing risk of further sclerotic/embolic effects

  • Antiplatelet therapy/Anticoagulation
  • Lifestyle modification
  • BP control if HTN
  • Statin therapy if elevated LDL cholesterol
  • Optimisation of glycaemic control if diabetic
  • Carotid endarterectomy if carotid stenosis >70%
  • Cholinesterase inhibitors or memantine if concomitant AD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

pathophysiology of lewy body dementia

A
  • Accumulation of lewy bodies in vulnerable sites of the CNS
  • Lewy bodies are composed of protein alpha-synuclein, a cytoplasmic protein associated with synaptic vesicles. Other proteins include neurofilament and ubiquitin
  • The distribution and density of Lewy bodies are thought to be correlated with clinical syndromes
  • Co-existing AD pathology is common
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

parkinsons or lewy body demenita

A

essentially the same disease as parkinsons

if movement disorder followed by dementia then we call this Parkinsons disease

if dementia precedes movement disorder we call this dementia with lewy bodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

lewy body history

A
  • Risk factor = old age
  • Cognitive fluctuations
  • Hallucinations, typically visual and complex; up to 80% of patients
  • Motor symptoms → Parkinsonian features present in >85% of patients
  • Vivid dreams are accompanied by loss of associated atonia of REM sleep; ‘acting out’ dreams
  • Depression
  • Repeated falls/syncope
  • Urinary incontinence
  • Constipation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

management of lewy body dementia

A

similar to alzheimers

carbidopa/ levodopa (movement)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

management of lewy body dementia

A

similar to alzheimers

carbidopa/ levodopa (movement)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

frontotemporal dementia pathophysiology

A

focal neurodegeneration of the front or temporal lobes of the brain

→ strong family history

Definitive diagnosis depends on the pathological examination of brain tissue, and identification of patterns of neuronal injury and characteristic intra-neuronal and glial cell inclusions. Specific accumulations found:

  • FTD-tau
  • FTD-U (ubiquitin)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Classification of FTD : 3 behavioural presentations

A
  • Apathetic
  • Disinhibited
  • Stereotypic

Can be overlapping

  • Distinction between behavioural FTD vs Primary progressive aphasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

history fo FTD

A
  • Coarsening of personality, social behaviour, and habits
  • Progressive loss of language fluency or comprehension
  • Development of memory impairment, disorientation, or apraxias
  • Progressive self-neglect and abandonment of work, activities, and social contacts
  • Age at onset peak in mid-50s
  • FHx
  • Altered eating habits
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

management of FTD

A

*not standard dementia medication*

Dependent on patient need:

  • Acute irritability, restlessness, agitation, or aggression → benzos
  • Home-assistance, respite care
  • Compulsions → SSRIs
  • Sleeping disturbance → Mirtazapine 1st line
  • Distractibility → amantadine
  • Gluttony → topiramate
27
Q

AIDs dementia complex pathophysiology

A
  • As patients with HIV infection live longer thanks to modern treatments, their chance of developing AIDS associated dementia is increasing
  • HIV-infected macrophages enter the brain, causing indirect damage to neurones
  • Insidious onset, but rapid progression once established
28
Q

Clinical features of AIDs complex dementia

A
  • Related to global damage but also some manifestations of cerebellar involvement:
    • Cognitive impairment
    • Psychomotor retardation (slow thoughts and movements, also seen in depression)
    • Tremor Ataxia Dysarthria Incontinence
29
Q

dementia investigations

A
  • mini mental state examination
  • dementia screen
    • FBC, U and E, TSH, vitamin B12
  • urine drug screen
  • CT head
  • MRI brain
  • ECG in vascular dementia
  • routine syphilis testing not necessary but should be done if risk is identified
30
Q

prognosis of dementia

A

vascular-→ step wise (stays the same and then gets much worse)

alzhemimers → progressively gets worse

lewy body → fluctuating (some normal days and progressive decline)

31
Q

dementia vs delirium

A

main thing: delirium is a reversible cause of confusion

32
Q

dementia vs delirium

A

main thing: delirium is a reversible cause of confusion

33
Q

falls can be divided into

A

syncopal or non syncopal

34
Q

A syncopal fall describes

A

a blackout and can be cardiovascular or neurogenic

  • Pre syncope describes the feeling of feeling like you are blacking out without losing consciousness
    • Lightheaded
    • Sweating
    • Pallow
    • Blurred vision
34
Q

A syncopal fall describes

A

a blackout and can be cardiovascular or neurogenic

Pre syncope describes the feeling of feeling like you are blacking out without losing consciousness

  • Lightheaded
  • Sweating
  • Pallow
  • Blurred vision
35
Q

non syncopal falls

A

mechanical (weakness), seizure etc

36
Q

mechanical fall is not a

A

cause of a fall as all falls are mechanical by definition

  • Falls can be accidental slip/trip type injuries
  • Often falls are multifactorial due to complex interactions
37
Q

falls history

A
  • What they were doing at the time of the fall?
  • Do they recall falling?
  • Did they injure themselves?
  • Did they feel dizzy or faint prior to falling?
  • Has this happened before?
  • How often do they fall?
  • If a syncopal fall (blackout) did they bite their tongue or were incontinent of urine
  • Beware of those that may be confabulating – do you need to check cognition prior to assessing?
  • How quickly did they recover?
  • How long were you on the floor for?
38
Q

key exmaiantion after a fall

A
  • Cardiovascular
    • Rate
    • Rhythm
    • Murmurs
    • ECG (24hr tape)
    • Lying and standing BP (postural hypotension)
  • Neurological
    • Gait assessment
  • Bloods
  • CT head only warranted if neurological deficits or if head injury (GCS <13)
  • MSK exam
39
Q

Management of falls

A
  • If suspicion the fall had a specific cause investigations must follow
  • Osteoporosis risk assesses
    • Those who fall and fracture large bones are usually given osteoporosis treatment straight away if over 75
40
Q

action after a fall

A
  • Basic advice
    • Drink plenty
    • Stand up slowly
    • Remove loose carpets/leads
    • Sensible slippers
    • Good lighting
  • OT assessment
  • Social work/ PCC assessment
    • Do they need more help at home?
  • Opticians/audiologists
  • If A and E write a complete GP letter
    • Needs a medication review
41
Q

common clinical challenges in assessing older people

A
  • Cant give proper history of falls/ other ailments that may increase likelihood of fall due to poor memory
  • Not wanting to lose independence
  • Lack of resources to assess older people
  • Elderly may not want to move house around to make it safe
42
Q

Practical solutions to minimise risk of falls

A
  • Clean up clutter
  • Remove tripping hazards
  • Install grab bars and handrails
  • Avoid loose clothing
  • Ensure lighting is right
  • Wear shoes
  • Make it nonslip
43
Q

what is syncope

A

transient loss of consciousness characterised by fast onset and spontaneous recovery

caused by reduced perfusion in the brain

usually self limiting- being horizontal will fix low BP

44
Q

types of syncope

A

reflex

orthostatic

cardiac

45
Q

reflex syncope

A
  • Disorder of the autonomic regulation of postural tone
  • Activation of part of medulla leads to decrease in sympathetic output and increase in parasympathetic
    • Decreased CO
46
Q

postural (orthostatic) hypotension

A
  • Symptoms occur after standing from a sitting or lying position
  • Can cause syncope if drop in blood pressure is severe enough
  • Normally defined as a drop of 20mmHg or more
  • The problem with standing
47
Q

Cardiac/cardiopulmonary disease- exertional syncope

A
  • Syncope caused by a cardiac disease of abnormality
  • Can be electrical, structural or coronary cause
  • Family history of cardiac disease or sudden cardiac death
  • Preceding chest pain or palpitation
  • Past medical history of heart disease
  • Abnormal ECG
    • Electrical
      • Bradycardias
      • Tachycardias
    • Structural
      • Aortic stenosis
      • Hypertrophic obstructive cardiomyopathy
    • Coronary
      • MI/IHD
48
Q

Seizures

A
  • A generalised tonic-clonic seizure is a cause of loss of consciousness and will cause a fall
  • However it is not syncope
  • Be are of new epilepsy in the elderly
  • 2nd peak in incidence rate is in over 80s
  • Seizure can often be subtle
49
Q

aortic stenosis and syncope

A
  • Narrowing of aortic valve
  • Harder to push blood through aortic valve
  • During exercise, when the heart has to work harder, the stenosis can limit CO and therefore fail to adequately perfuse the brain
  • If AS with syncope- survival of 2-5 year if untreated
50
Q

Medications which may cause falls

A
  • Antihypertensives
    • hypotension
  • Drugs which reduce blood glucose
    • Hypoglycaemia
  • Medications which effect the brain
    • i.e. cause sedation of drowsiness
51
Q

drug history falls

A
  • Polypharmy
  • Any new medications
  • Anti-hypertensives/ anti-arrhythmias
  • Any drug which may induce drowsiness?
    • Analgesia
    • Benzodiazepine
    • Antidepressants
    • Antipsychotics
  • Have they had a recent medication review
52
Q

Case 1

  • Admission to medical admissions unit
  • 90yr old man called - Fred
  • Referred as “off legs” and “fall”
  • No history of previous falls.
  • Past medical history – Hypothyroidism
  • On Levothyroxine 75mcg, Lansoprazole 15mg, Aspirin 75mg
  • Lives at home. Mobile with a stick and no package of care.
  • Reportedly fell as he lost his balance due to heavy legs

Required investigations:

A
  • An ECG is important to assess for an arrhythmia contributing to a fall
  • Lying and standing blood pressure are important to assess for postural drop in blood pressure
  • Routine bloods may look for an underlying contributing illness
    • A CT head is only warranted if there is a neurological deficit or if the person has sustained a head injury and has a GCS less than 13, focal neurological deficit or vomiting. If a person is on anticoagulation and has sustained a head injury a CT head should be performed.
53
Q

Case 2

  • 89 year old man - Stanley
  • Presented to hospital with recurrent falls
  • He lives alone with a QDS package of care
  • He has had a cough and shortness of breath for 2/52
  • He is diagnosed with AKI and Pneumonia (CURB 65 =3)
  • He is stepped down to community hospital for rehabilitation
  • Discharge planning is commenced at the community hospital
  • Concerns are raised over undiagnosed cognitive issues (CT shows moderate/severe SVD)
  • The therapy team feel he has poor balance, axial skeleton sarcopenia and is taking risks
  • Stanley is reportedly unaware of risks associated with using the stairs and his inability to get off the floor
  • Son raises concerns over safety at home despite QDS carers
  • Stanley is adamant he wants to go home

DOES HE HAVE CAPACITY TO DECIDE?

A

Mental Capacity Act 2007

To have capacity a person must be able to :

  • Understand the information relevant to the decision
  • To retain that information
  • To weigh that information as part of the process of making a decision
  • To communicate his/her decision

When a person lacks capacity

  • Make care of patient first concern
  • Treat patients as individuals and respect their dignity
  • Support patients to be involved
  • Treat patients with respect and do not discriminate against them
  • Use any advocates the person may have previously identified
  • Decisions must take into consideration what the person would have wanted should they have had the capacity to make a decision
54
Q

define frailty

A
  • Age- related syndrome (>65)
  • Decline in physical and mental resilience/reserve
  • Vulnerable to adverse health outcomes
55
Q

assessments for frailty

A
  • Assessment
    • Bed side
      • Walking speed
      • Timed up and go test
    • Primary care: eFI
      • Electronic frailty index (based on rockwood)
        • Good predictor of hospitalisation, nursing home, mortality
    • Secondary care: Rockwood (clinical frailty scale)
56
Q

rockwood

A

clinical frailty scale

57
Q

geriatric giants

A
  • Geriatric giants
    • Immobility
    • Instability (Falls)
    • Incontinence
    • Impaired memory (Dementia, Delirium)
    • Iatrogenesis (Caused by us!)
58
Q

often geriatric presentations are

A

non specific

  • Frail older people will often not have the ‘classic’ symptoms of common illnesses.
59
Q

Gold standard Intervention for Frailty

A

Comprehensive geriatric assessment (CGA)

60
Q

comprehensive geriatric assessment

A
  • Multidisciplinary diagnostic and treatment process
  • Can be carried out in multiple setting
  • Reduces mortality
  • Increases living in own home
61
Q

physiological definition of frailty

A

Clinically recognizable state of increased vulnerability resulting from ageing- associated decline in reserve and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is comprised.

62
Q

phenotypic definition of frailty

A

Low grip strength, low energy, slowed waking speed, low physical activity, and/or unintentional weight loss.

63
Q

frailty and outcomes

A

Medicine block (Y3) (38 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions