COTE

Question 1

What are the challenges with caring for older people?

Answer 1

Frailty
Complex comorbidity
Different pattern of disease presentation
Slower response to treatment

Question 2

What is frailty?

Answer 2

State of increased vulnerability, resulting from ageing-associated decline in reserve and function across multiple physiologic systems, such that the ability to cope with every day or acute stressors is compromised.

Question 3

What are the 4 most common presentations in COTE?

Answer 3

1) falls
2) confusion
3) incontinence
4) social admission

Question 4

What is acopia?

Answer 4

Inability to cope

Question 5

What are intrinsic RF for falls?

Answer 5

• vision
• walking ability
• maintaining balance
• muscle strength
• physical activity endurance

Question 6

What are extrinsic RF for falls?

Answer 6

Environment
- lighting
- slippery floors
- rugs
- walking stick
- footwear
-

Question 7

How do you treat falls?

Answer 7

Physio
- strength + balance training

OT
- environment: baths, toilet, dressing rails

Medical

• polypharmacy issues
• stop antihypertensives
• give fludrocortisone to increase circulatory volume = increase BP
• give calcium + vitamin D to increase muscle strength

Question 8

Why is creatinine clearance more reliable than eGFR?

Answer 8

Creatinine clearance takes into account weight.

Question 9

Describe features of delirium

Answer 9

• acute onset
• fluctuating course
• impaired attention
• decreased consciousness
• usually reversible
• often accompanies physical illness
• hospital acquired

Question 10

Causes of delirium?

Answer 10

Drug use (introduction, dosage adjustments)
Electrolyte + physiological abnormalities
Lack of drug (withdrawal)
Infection
Reduced sensory input (blind, deaf, changing environment)
Intracranial problems (stroke, post-ictal meningitis)
Urinary retention + faecal impaction
Myocardial (MI, arythmia, heart failure)

Question 11

RF for delirium

Answer 11

significant injuries
terminal illness
older age
lack of stimulation
cognitive impairment
frailty 
poor nutrition 
hx of alcohol excess
sensory or functional impairment

Question 12

Clinical Sx of delirium

Answer 12

• acute behavioural change
• altered social behaviour
• altered level of consciousness
• falling + loss of appetite

Question 13

List 4 methods of cognitive screening?

Answer 13

1) 6 CIT
2) MMSE
3) MOCA
4) Addenbrookes

Question 14

What are some reorientation strategies for delirium?

Answer 14

• easily visible and accurate clocks + calendars
• continuity of care from nursing staff
• discourage napping
• encourage bright light exposure in daytime
• encourage family + friends to visit

Question 15

Medical Tx for delirium?

Answer 15

• treat underlying cause

- low dose haloperidol + lorazepam

Question 16

RF for pressure ulcers?

Answer 16

• age>70yrs
• bedridden
• paralysis
• paralysis obesity
• urinary/bowel incontinence
• poor nutrition
• diabetes
• peripheral arterial disease

Question 17

what is the scoring system for pressure ulcers?

Answer 17

WATERLOW scoring system

Question 18

prevention of pressure ulcers?

Answer 18

1) barrier creams
2) pressure redistribution + friction reduction
- special foam mattress
- heel support
- cushions
3) repositioning
4) regular skin assessment

Question 19

what are causes of malnutrition?

Answer 19

1) decreased nutrient intake
- vomiting
- nausea
- dysphagia
- mood
- hospital
- NBM
2) increased nutrient requirements
- major surgery
- wound healing
- pressure sores
3) inability to utilise
e. g. malabsorption or IBD

Question 20

Consequences of malnutrition?

Answer 20

1) immune system (decreased ability to fight infection)
2) muscle wasting (causes falls, decreased mobility)
3) impaired wound healing
4) micronutrient deficiencies

Question 21

What screening tool is used in malnutrition?

Answer 21

Malnutrition
Universal
Screening 
Tool 
(MUST)
- takes into account BMI, weight loss score + acute disease effect score

Question 22

How to treat malnutrition?

Answer 22

1) food
- snacks, nourishing drinks, food fortification
2) oral nutritional supplements
3) enteral/parental nutrition

Question 23

What is refeeding syndrome?

Answer 23

Group of clinical signs and symptoms that can occur in a malnourished patient when reintroducing nutrition. There is a shift in use of energy stores from fat metabolism to carbohydrate metabolism.
It initiates insulin increase + cellular uptake of potassium phosphate and magnesium. Can result in death.

Question 24

Mx of refeeding syndrome?

Answer 24

• IV Pabrinex of thiamine or VitB prior to feeding
• Slow reintroduction of nutrition
• Daily monitoring