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Geriatrics Flashcards

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1
Q

What is a key tool in geriatric history/exam?

A

collateral history…paramedics, carers, family, GP

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2
Q

What are key aspects of social history that you must inquire about in geriatric history?

A

social support- carers, family support?

activities of daily living- requires assistance or independent?

continence

cognition

mobility- falls, walking aids, mobility around house

exercise tolerance

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3
Q

What aspects of physical examination are important in a geriatric exam?

A

vision and hearing
swallow, nutrition, hydration
bladder and bowel
injury
skin

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4
Q

Name two other allied professionals who are involved in the care of geriatric patients?

A

occupational therapist- improving every day life, prevent falls, memory rehab, home modifications, help with vision loss

Social worker- connecting to appropriate services, community resources

dietitian

speech and language therapist

physio

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5
Q

What criteria is used to assess frailty?

A

fried frailty criteria

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6
Q

Name two components of the fried frailty criteria

A

weight loss, exhaustion, low physical activity, slowness and weakness (measured by grip strength)

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7
Q

A patient has a score of 3 on fried frailty criteria. Are they frail?

A

> 3 = frail
1-2= pre-frail

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8
Q

Name one frailty index/scoring system

A

ROckwood’s frailty index- the more things you have wrong the more likely you are going to be frail

fried frailty criteria

Edmonton frail scale

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9
Q

List three common problems in frailty

A

falls
cognitive impairment
continence
mobility
nutrition
polypharmacy
mood
loneliness
alcohol
vision
hearing

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10
Q

Which is the most helpful tool for frailty for medical students?

A

Health improvement Scotland frailty score

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11
Q

Name one key thing that can be done to improve health outcomes for frail people when they first begin to show evidence of physical and mental decline

A

comprehensive geriatric assessment CGA- specialist care

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12
Q

What is a bedside frailty score?

A

FRAIL acronym

Functional decline- self care
Residential care
Acute or chronic confusion
Immobility
Living with support at home

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13
Q

Which tests should you do to rule out delirium and depression?

A

4AT
GDS- geriatric depression scale

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14
Q

How does pharmacokinetics change with age?

A

absorption- low HCL secretions
Less body water and more body fat- impact on half life
Elimination- high first pass metabolism, reduction in doses e.g. morphine
Reduction in creatinine- impairment of renal excretion

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15
Q

How does pharmacodynamics change with age?

A

increased sensitivity to medication due to changes in receptor numbers and response

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16
Q

What is risperidone?

A

antipsychotic

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17
Q

What is the impact of risperidone on dementia?

A

increased risk of stroke and roles, caution in elderly

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18
Q

List two contributing factors to polypharmacy

A

seeing multiple doctors
failure to review
severe chronic disease
care home
admission
failure to recognise non concordance= not actually taking the medications

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19
Q

What is number needed to treat?

A

The Number Needed to Treat (NNT) is the number of patients you need to treat to prevent one additional bad outcome (death, stroke, etc.). For example, if a drug has an NNT of 5, it means you have to treat 5 people with the drug to prevent one additional bad outcome.

The lower the number the better

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20
Q

List three classes of drugs that should be stopped in person who is unwell

A

ACEi
ARBs
NSAIDs
Diuretics
Metformin

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21
Q

How do water and fat content change with increasing age?

A

increase in total body fat
decrease in total body water

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22
Q

List three causes of weight loss?

A

poor dentition
swallowing difficulties
cognitive impairment
access/environment
poor appetite
low mood

chronic disease
acute illness/injury –> inflammation

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23
Q

List two risk factors for pressure ulcers

A

sarcopenia
malnutrition
immobility
neurological damage
medical conditions
incontinence

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24
Q

List two medical conditions that increase the risk of pressure sores

A

COPD
dementia
CVA
fracture/surgery
malignancy

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25
List the grades of pressure ulcers
Grade 1- non blanching erythema Grade 2- Partial thickness skin loss Grade 3- Full thickness skin loss Grade 4- Full thickness tissue loss
26
List two strategies to improve outcome of skin ulcers
keep repositioning incontinence and moisture skin inspection surface- redistribute body weight nutrition and hydration
27
List three types of incontinence
Passive/functional Overactive bladder/urge Stress incontinence Overflow
28
Two causes of stress incontinence?
child birth chronic cough obesity
29
Management of stress UI?
lifestyle advice pelvic floor exercises pads surgery
30
Two causes of urge incontinence
neurological conditions- MS, dementia, PD small capacity bladder UTI
31
Management of urge incontinence?
pelvic floor exercises bladder retraining anticholinergics B3 agonist Botox into bladder wall
32
Two causes of overflow UI?
enlarged prostate constipation pelvic mass neurological conditions
33
List two components of an examination to assess urinary incontinence?
PR Skin Stand patient up/cough Vaginal exam Cognitive assessment Check skin if concern for dementia/immobility
34
Red flags for urinary incontinence?
pelvic pain haematuria back pain loss of senstion/tone
35
Investigations for urinary incontinence?
urine dip/culture frequency volume diaries post voidal bladder scan blood tests- WCC/CRP, Hb- new anaemia, PSA- prostate
36
List two hallmarks of diagnostic features of delerium
1. Cognitive impairment 2. Fluctuation in levels of consciousness/drowsy 3. Inability to focus/inattentive
37
List three causes of delerium
infection drugs constipation pain urinary retention dehydration
38
Does syncope increase mortality?
no
39
List two characters of syncope
loss of postural tone transient global cerebral hypoperfusion characterised by rapid onset, short duration and spontaneous recovery
40
Name three causes of syncope
reflex- (trigger) vasovagal, carotid sinus, situational (cough, laugh) Orthostatic hypotension= postural hypotension Cardiac
41
List two causes of postural hypotension/orthostatic hypotension
medications hypovolaemia/dehydration hypoadrenalism- short synacthen test Primary autonomic dysfunction e.g. idiopathic parkinson's disease secondary autonomic dysfunction e.g. diabetes, lambert eaton syndrome, infections e.g. HIV
42
Specific questions to ask about syncope in relation to orthostatic hypotension?
prodromal symptoms diet/fluid intake alcohol?? eyewitness account recovery period standing sitting hot bath? DRIVING
43
Management of orthostatic hypotension?
identify triggers improve hydration medication review 24 hour BP monitor
44
List three differentials for delerium
dementia deaf/blind depression dysphasia different language alcohol- withdrawal
45
List three differences between delirium and dementia
Onset- acute vs insidious Course- fluctuating versus progessive Conscious- clouded vs clear Hallucinations vs absent Delusions vs absent Hyper/hypo activity vs normal
46
List a screening test for delerium
4AT CAM- confusion assessment method
47
Difference between 4AT and AMT4?
AMT4- abbreviated mental test: age, DoB, place, year, indicates cognition while 4AT is delirium tool
48
List two personal factors that increase risk of delirium
male older age dementia depression alcohol sensory impairment
49
List two environmental factors that precipitate delerium
severe medical illness polypharmacy surgery dehydration malnutrition sleep deprivation
50
List three complications of delerium
increases risk of future dementia increased mortality increased hospital stay PTSD pressure sores falls pneumonia increased readmission rates
51
What is the management of delirium?
target risk factors- dehydration, sensory loss, immobility, polypharmacy TIME burdle re-orientation address pain antipsychotics
52
List three domains that dementia affects
memory orientation comprehension learning capacity calculation language judgement
53
Three differentials for dementia?
delirium depression iatrogenic- anticholinergic medications physical illness- anaemia, thyroid dysfunction
54
List one cognitive test you would use to assess dementia?
MMSE Montreal cognitive assessment MoCA Addenbrookes cognitive exam
55
List three components of dementia screening bloods?
FBC U+E LFT CRP Bone profile Haematinics TFT
56
Discuss the pathophysiology of dementia
amyloid plaques and neurofibrillary tangles (tau hyperphosphorylation) causing atrophy
57
Which regions of the brain are affected most in alzheimer's disease
mediotemporal e.g. hippocampus
58
List one genetic risk for dementia
presenellin 1 and 2 amyloid precursor protein APP
59
In which type of dementia should you be cautious with antipsychotics?
lewy body dementia
60
List two classes of drugs used in the treatment of dementia
acetylcholinesterase inhibitors e.g. rivastigmine NMDA antagonist e.g. memantine
61
Name one contraindication for acetylcholinesterase inhibitors?
bradycardia or 2nd degree heart block
62
List two psychological treatments for dementia
cognitive stimulation therapy grou memory management group patient and carer education
63
List two aspects of social treatment for dementia
power of attorney/guardianship Home care, help with shopping etc OT assessment (kitchen, baths) Managing risk (smoke detectors, telecare, alarms, locked meds box)
64
List four aspects of memory/dementia history you would take
daily tasks- cooking/dressing/cleaning mobility paying bills Word finding Mood/interests/attention Using gadgets- tv remote, phone falls black outs hallucinations empathy? taking medications?
65
What is the difference between parkinson's disease dementia and lewy body dementia?
If symptoms start >1 year after motor syx= PDD If symptoms dementia start <1 year after or before motor symptoms= Lewy body dementia
66
What are the key features of sporadic creutzfeldt jakob disease?
rapidly progressive dementia- memory, language, behaviour changes Motor symptoms- ataxia, myoclonus, rigidity Later stages- bed bound.... 4 month prognosis from onset of symptoms!!
67
List three ways in which distress can manifest in behaviour
physical aggression verbal aggression self harm shouting lack of self care stripping sleep problems inappropriate sexual behaviors spitting
68
List two biological causes of physical aggression
alcohol withdrawal Pain Drug induced Frontal lobe deficit
69
List two psychological causes of aggression
frustration from being: misunderstood inability to communicate well inability to understand embarrassed during personal care
70
List two social causes of aggression
does not like being touched prevented from leaving building not liking carer e.g. due to age, sex
71
Two causes of excessive walking
distraction from pain drug induced boredom sense of control hungry
72
Patient is sleepy and is picking at the air and at their clothes. What is this a classic sign of?
delirium!!
73
Which anti psychotic can be used to calm/sedate distressed patient?
risperidone, in small doses
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