Geriatrics

Question 1

Age related changes and conditions in geriatrics

Answer 1

• Presbyopia → hardening of lens (close vision problems)
• Senile cataracts → lens clouding (progressive vision dimming)
• Maculopathy → thickening, sclerotic changes in retinal basement membrane complex (painless vision changes, distortion of central vision)
• Hyposmia → neural degeneration (decline in sense of smell)
• Presbycusis → loss of eight CN sensitivity (difficulty appreciating content of conversation in noisy environment)
• Cerumen impaction → conductive hearing loss

Question 2

What is macular degeneration?

Answer 2

Most common cause of newly acquired blindness and vision loss in elderly

• Loss of central vision field
• Risk factors: European descent, women, smoking, family history, excessive sun exposure
• Ophthalmological exam → hard drusen or yellow deposits in macular area

Question 3

Age related changes that should be considered when prescribing medications

Answer 3

• Lower percentage of body weight as water
• Reduction in lean muscle mass
• Low serum albumin
• Reduced kidney weight
• Reduced hepatic blood flow

Question 4

Medication classes that are associated with increased fall risk

Answer 4

• Anxiolytics and hypnotics → benzodiazepines
• Antidepressants → TCAs (amitriptyline), SSRIs (sertraline, citalopram)
  
  • Orthostatic hypotension
• Neuroleptics (haloperidol) and antipsychotics → SGA (risperidone)
  
  • Orthostatic hypotension, dizziness
• Opioid
  
  • Sedation
• Insulin (sulfonylureas)
  
  • Drug-induced hypoglycemia
• Cardiac medications (diuretics, CCBs, beta blockers, nitrates)
  
  • Orthostatic hypotension, dizziness

Question 5

What are the most common causes of delirium?

• DELIRIUMS mnemonic

Answer 5

• Drugs
• Emotional, electrolyte disturbance (hyponatremia)
• Low PO2, lack of drugs (withdrawal from alcohol, etc)
• Infection
• Retention of urine or feces, reduced sensory input
• Ictal or postictal state
• Undernutrition
• Metabolic, myocardial problems
• Subdural hematoma

Question 6

Diagnostic criteria for Alzheimer’s disease

Answer 6

Gradual onset of memory impairment plus 1+ of the following:

• Aphasia
• Apraxia (impairment of motor activities despite intact motor function)
• Agnosia (failure to recognize objects despite intact sensory function)
• Executive functional disturbance

Question 7

Alzheimer’s disease (dementia) treatment and management

Answer 7

Medications

• Mild to moderate stages
  
  • Cholinesterase inhibitors → donepezil (aricept), tacrine (cognex), rivastigmine (exelon)
• Moderate to severe stages
  
  • NMDA receptor antagonist → memantine (namenda)
    
    • Can be used in combination with cholinesterase inhibitors

Regular physical activity