Geriatrics

Question 1

Delerium

Answer 1

Acute, fluctuating change in mental status with inattention, disorganised thinking and altered levels of consciousness

Question 2

Types of delerium

Answer 2

• hypoactive: lethargy, decreased motor activity, incoherent speech, lack of interest
• hyperactive: restless, agitation, hallucination
• mixed

Question 3

What are the causes of delerium?

Answer 3

• change in environment and sensory impairment
• UTI
• constipation
• Hypoxia
• infection
• metabolic disturbance
• pain
• nurtrition
• lack of sleep
• hypothermia/pyrexia
• organ dysfunction
• environmental change

Question 4

Investigation for delirium

Answer 4

• cognitive assessment: MMSE, AMTS
• confusion screen: FBC, UEs, LFTs, coagulation/INR, TFTs, calcium, B12, folate, glucose, blood cultures
• urinalysis
• consider imaging

Question 5

What is the management of delerium?

Answer 5

• identify and treat the cause
• keep a consistent nursing and medical team
• ensure patient is as independent as possible and has required aids
• clock and orientation reminders, familiar objects, involve the family
• Haloperidol if necessary

Question 6

What are the common causes of dementia?

Answer 6

• alzheimers
• cerebrovascular disease (vascualr alzheimers)
• lewy body dementia

Question 7

Alzheimers disease

Answer 7

• memory loss
• loss of social and occupational functioning
• diminished executive function
• speech and motor deficit
• personality change
• behavioural and psychological disturbance

Question 8

Investigation for alzheimers

Answer 8

• bedside cognitive
• FBC to rule out anaemia
• metabolic panel
• TSH to rule out thyroid
• B12
• CT/\MRI

Question 9

Management of alzheimers

Answer 9

• supportive care: education, support, resources
• Occupational therapist: home safety evaluation
• Cholinesterase inhibitor: donepezil

Question 10

presentation of lewy body dementia

Answer 10

• hallucination
• delusion

Question 11

What is malnutrition?

Answer 11

BMI<18.5 or unintentional weight loss greater than 10% with the last 3-6 months or a BMI of <20 and unintentional weight loss of >5% within the last 3-6 months

Question 12

Screening for malnutrition

Answer 12

MUST

Question 13

Investigation for malnutrition

Answer 13

• FBC
• urinalysis
• serological testing for coeliac disease

Question 14

What is the management of malnutrition?

Answer 14

• Dietician if high risk
• food first approach with clear instruction
• oral nutritional supplements between meals

Question 15

What are the complications of malnutrition?

Answer 15

• impaired immunity
• poor wound healing
• growth restriction
• unintentional weight loss
• multi organ failure

Question 16

What is sarcopenia?

Answer 16

Loss of skeletal muscle mass and strength

Question 17

Investigaation for sarcopenia

Answer 17

• grip strength
• muscle mass DXA
• gait speed/timed up and go test

Question 18

What are the causes of sarcopenia?

Answer 18

• nutritional
• inactivity
• disease: bone/joint, metabolic disorder, endocrine, cancer
• iatrogenic

Question 19

How can you differentiate between sarcopenia and malnutrition?

Answer 19

• Sarcopenia: Decreased muscle mass and strength
• Malnutrition: decreased muscle mall with normal strength

Question 20

What is the management of sarcopenia

Answer 20

• resistance exercise

Question 21

What is the presentation of depression?

Answer 21

• depressed mood/loss of interest, most of the day, everyday for 2+ weeks
• diminished pleasure/interest in all/most activities everyday for 2+ weeks (anhedonia)
• functional impairment
• weight change
• libido change
• sleep disturbance
• low energy, poor concentration, excessive guilt
• suicidal ideation

Question 22

Investigation for depression

Answer 22

• FBC
• metabolic panel
• TFTs

Question 23

Management of depression

Answer 23

• psychosocial intervention (CBT/guided self help/mindfulness). Antidepressant if patient preferance (SSRI)

Question 24

SSRI

Answer 24

Citalopram or sertraline

Question 25

What are the complications of depression?

Answer 25

- suicide - substnace misuse - persistnet symptoms - recurrence - reduced quality of life

Question 26

What is multimorbidity?

Answer 26

Presence of two or more long term health conditions including: defined physical or mental health conditions, learning disabilities, symptoms complexes such as chronic pain, sensory impairements and alcohol or substance misuse

Question 27

What are the risk factors for multimorbidity?

Answer 27

- age - female - low socioeconimic status - tobacco and alcohol usage - lack of physical activity - poor nutrition adn obesity

Question 28

What are the complications of multimorbidity?

Answer 28

- decreased quality of life and life expectancy - increased treatment burden - mental health issues - polypharmacy - negaitv eimpacts on carers welfare

Question 29

Assessment of multimorbidity

Answer 29

- establish the extent of disease burden - ask about social circumstances - assess adequacy of pain management - assess frailty through gait speed, PRISMA-7 or self reported health status

Question 30

Management of multimorbidity

Answer 30

- maximise benefits of existing treatments - reduce numbers of high risk meds and consider non pharmacological interventions - STOPP/START - individualised managment plan - promote self management - support carers and families