Week 3 Flashcards
What s frailty?
Defined as a medical syndrome:
- multiple cause and contributors
- diminished strength and endurance
- reduced physiological function
- Increase an individual’s vulnerability
What are the stages of the clinical frailty scale?
- Very fit
- Well
- Managing well
- Vulnerable
- Mildly frail
- Moderately frail
- Severely frail
- Very severely frail
- Terminally ill
What are the challenges faced with frail patients?
• Multiple Diagnoses, some long-term, some acute
• Presentations with non-specific S&S
- Underlying pathology not obvious
- Complexity of Hx taking and physical examination
- ^prevalence of mental, function and social issues
- Polypharmacy
- ^vulnerability to, poor recovery from, stressor events
- Balancing between quality and quantity of life (ethical considerations)
- ^prevalence of cognitive dysfunction
What are some assessment limitations with frail patients?
- Multiple symptoms
- Multiple Co-morbidities
- Polypharmacy
- Sensory Impairment
- Cognitive Impairment
- Social and environmental limitations that impact upon their health
What should you consider when assessing frail patients?
- Cognitive State (vs Pt’s normal)
- Nutritional State
- Sensory Impairment (PHx of neuro event?)
- Musculoskeletal issues and gait
- Pressure Area
- Postural BP
What happens in regards to fat composition with ageing?
Increased Fat composition, more centrally distributed
- ^ Waist Circumference
What happens with body water content in regards to ageing?
Decreased total body water
- Intracellular fluid loss
What happens with bone and muscle mass with ageing?
Decreased Bone and Muscle Mass
- Bone mass peaks at 25-30
- Atrophy, Hormonal changes, Neuronal degeneration, Impaired protein synthesis
What happens with immune function with ageing?
Decreased immune function:
- B-cell numbers are preserved, but decreased specific antibody and increased autoantibody production
- T-Cell numbers are decreased, reduced activation in respond to both new and recognized antigens
- Decreased seroconversion and seroprotection rates following vaccination
- 20-30% of older patients have a diminished febrile response to infection
What happens with vessel wall compliance with ageing?
Reduced vessel wall compliance:
- Reduced elastin, increased collagen and calcium deposit
- Endothelium is less responsive to vasoactive substances
WHat happens to BP with ageing?
Reduced ability to maintain BP
- Decreased baroreceptor sensitivity
What happens with cardiac function with ageing?
Reduced cardiac function
- Decreased elastin and increased collagen and calcium deposition > impairs diastolic relaxation
- Resting HR and CO remain stable, but peak HR and EF decline
- Heart valve undergo sclerosis due to calcification
- Conduction system undergo fibrosis and fatty change with predisposition to arrthymias
What happens with lung compliance with ageing?
Reduced lung compliance
- Reduced elastic recoil of lung, decreased respiratory muscle strength
What hasppens with renal function with ageing?
Reduced renal function
- Loss of renal mass after age of 40
- Mostly in the cortex, with loss of nephrons
- Thickening of basement membrane
- Increased renal artery resistance > reduced kidney blood flow
WHat happens wth GI suystem wth ageing?
More likely to have GI problems
- Reduced oesophageal motility > impaired swallowing + GORD
- Weakened connective tissue within colonic mucosa > formation of diverticula
- Change in prostaglandin levels and chronic Helicobacter pylori infection > Atrophic Gastritis
Define polypharmacy?
• Being prescribed with 5 or more medications
- > 1/3 of geriatric populations affected
what are some issues around polypharmacy in elderly?
- Risk of inappropriate prescribing
- Dose, duration, contra-indicated drugs, etc
- ↑ Risk of side-effects
- ↑ drug-drug interactions and risk of Adverse Drug Reactions (ADR)
- Higher prevalence of chronic disease
- Most drug researches based on young healthy individuals
- Do not have multiple comorbidity or polypharmacy
What is osteoperosis?
Progressive loss of bone mass
Common – 1/3 of women over 50 YO (post menopause) would sustain a osteoporotic #
• Shift towards bone resorption
- Reduction of net bone mass
Associate with excess morbidity and mortality
• 33% die and 35% require help to walk one year after hip#
What are risk factors for osteoperosis?
Female Previous fragility # Maternal Hx of Hip# Current Smoker ETOH ( >3 units/day) Glucocorticoid (>3 months @ dosage >5mg D) Low Calcium + Vit D deficiency Low BMI
Osteoperosis can be secondary to which diseases?
RA Hyperthyroidism, para-hyperthyroidism Premature Menopause (<45YO) Chronic malnutrition, malabsorption (e.g. Coeliac) Chronic Liver Disease
What are the categories of Dizziness and syncope with geriatrics?
Vertigo Presyncopal Unsteady Psychogenic Mixed
WHat is syncopy?
- Transient LOC due to transient global cerebral hypoperfusion
- Rapid Onset
- Short Duration
- Complete Recovery
- More common in geriatrics
- Men are more likely to have cardiac cause syncope
What are some differental diagnosis for syncope?
• Epilepsy
• Metabolic Disorders (e.g. hypoxia, hypoglycaemia)
• Intoxication
• Vertebrobasilar TIA
• Cataplexy
- Sudden and uncontrollable muscle weakness / paralysis
- Often triggered by strong emotion
- Drop attacks
- Falls
- Psychogenic pseudosyncope
What is parkinsonism?
Parkinsonism is a clinical syndrome characterized by: Bradykinesia (slow movement) Rigidity Tremor Hypomimia (expressionless face) Abnormal gait
WHat are the types of parkinsonism?
Idiopathic Parkinsons disease Vascular parkinsonism Drug-induced parkinsonism Lewy body dementia Progressive supranucular palsy Multi-system atrophy
What is dementia?
Impairment of memory and other higher cortical process
Progressive (usually irreversible)
WHat are the classifications of dementia?
Alzheimers disease Vascular dementia Mixed dementia Other subtypes: - Lewy body frontotemporal huntingdons alcohol-related progressive supranuclear
What is alzheimers
- Most common (62%)
* Caused by brain degeneration
What is vascular dementia
- Second most common (17%)
- Problem with cerebral blood supply
- Could be further subtyped
WHat is delerium?
State of mental confusion that develops quickly, usually fluctuates in intensity
Pathology still poorly understood
• Acetylcholine inhibition or pro-inflammatory cytokines may play a role
• Exacerbated by intercurrent illness or metabolic disturbance
WHat defines delirium in the DSM IV?
- Disturbance of consciousness, reduced ability to focus or shift attention
- Changes in cognition or development of perceptual disturbance
- Disturbance develops over a short period of time and fluctuates over the course of the day
- Hx supports an underlying condition, medication withdrawal or intoxication
What is a stroke?
Interruption of cerebral blood supply
• Haemorrhagic
• Ischemic
Clinical syndrome of focal neurological deficit of presumed vascular origin
Sudden Onset
Last for > 24 hours
What is a TIA?
“Mini-Stroke”
Temporary interruption of cerebral blood supply due to blood clot
Symptoms last for < 24 hrs
• Most resolved within minutes
What is urinary incontinence?
Common but underdiagnosed and poorly managed
Females are twice likely affected
• Chronic UTI?
35% of community-dwelling over-65YO
More common in care-home residents
^risk of UTIs
What is hypertension an important risk factor for?
- Cardiovascular Disease
- Cerebral Vascular Disease
- Renal Disease
Could be secondary to kidney and liver issues
What are common hypertension medications?
Betablockers
• Metoprolol, Atenolol
ACE-Inhibitors
• Perindopril, Ramipril
Calcium Channel Blockers
• Amlodipine, Felodipine
Angiotensin Receptor Blockers
• Candesartan, Irbesartan
WHat is heart failure?
Cardiac output reduced > insufficient to perfusion needs
Various types
Could be secondary to ACS
• Cardiac Remodelling
Could cause arrhythmias
• A.I.C.D.? P.P.M.?
What is ejection fraction and the various grades for it?
The amount of blood that LV pumps out with each contractions
• Measurement in percentage Grade 1: >60% Grade 2: 40-59% Grade 3: 20-39% Grade 4: <20%
What is olliguria?
Low urine output
According to RIFLE (Risk, Injury, Failure, Loss, and End-Stage Renal Failure)
• <0.5ml/kg/hr for more than 6/24 at a time (high risk AKI)
• <0.5ml/kg/hr for more than 12/24 at a time (positive risk AKI)
• <0.3ml/kg/hr for more than 24/24 at a time (acute renal failure)
What is elder abuse?
A single or repeated act or lack of inappropriate action
• Causes harm or distress to an elderly
An elderly is deliberately harmed, mistreated, exploited or neglected
Can take place in a person’s own home or in an institution
What are the risk factors for elder abuse?
- Disability
- Dementia
- Cultural background (Gender inequalities)
- Financial dependence (either the abused or abuser)
- Quality of relationship before the disability
- Backgrounds where violence is tolerated
- Cohabitation
- Poverty and lack of social inclusion
- Carer with Hx of violence, substance misuse or mental health problems
What are the types of elder abuse?
Physical Financial Psychological Neglect Sexual Discrimination Institutional
What is idiopathic parkinsons disease?
- unilateral onset
- upper limb predominance
- treatment responsive
- presenting with bradykinesia
What is vascular parkinsonism disease?
- lower limb predominance
- bilateral onset
- presentation with falls and gait problems
What is lewy body dementia?
prominent cognitive impairment presenting at teh same time as parkinsonism
- prominent hallucinations
- fluctuations in level of consciosuness
