Geriatrics

Question 1

Complications of a ‘long lie’

Answer 1

HIP DERP

Hypothermia
Infection
Pressure sores

Dehydration
Electrolyte abnormalities
Rhabdomyolysis
Psychological concerns

Question 2

percentage of falls resulting in fracture or hospitalization?

Answer 2

5% in community, 10-25% in residential care

Question 3

RFs for falls!

Answer 3

Intrinsic; poor autonomic control, vision/hearing problems, sensory/proprioceptive abnormalities, poor reaction time
Extrinsic; unsafe home environment, medications (esp antidepressants, sedatives, polypharmacy >/4)
Behavioural; unsafe activities, dementia
MANY MORE

Question 4

Prevention of falls;

Answer 4

Vitamin D, Ca
Strength training, balance programs and sun exposure
Cataract surgery
Home hazard assessment and modification
Physio to select gait aid

Question 5

Examination of falls patient;

Answer 5

Neurological, cardiac, cognitive, visual exam
Rhomberg’s
Timed up and go

Question 6

can enduring power of attorney make medical decisions?

Answer 6

No

Question 7

What’s in an ACD?

Answer 7

• Medical treatment preferences based on religious or other beliefs
• Conditions or states that the person would find unacceptable, for instance having a limb amputated
• How far treatment should go for incurable or terminal conditions
• A “responsible person” to make decisions in the event that the individual loses capacity
• Non-medical issues that are important to the individual

Question 8

Does someone have the right to insist on CPR?

Answer 8

No, doctors can refuse a futile treatment

Question 9

Effect of body fat changes in elderly?

Answer 9

Proportion increases, therefore lipid soluble drugs have longer half-lives (e.g. diazepam)

Question 10

Effect of water volume changes in elderly?

Answer 10

Decreased total body water, therefore increase in concentration of water soluble drugs (digoxin, lithium sotalol, atenolol, paracetomol)