DPD Stuff > Geriatrics > Flashcards

Geriatrics Flashcards

(26 cards)

Study These Flashcards
1
Q

What proportion of >75 are in care homes?

A

7%

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2
Q

How may old people present?

A 
• Complexity
• Frailty
• Functional / psychosocial
• Non-specific presentations / syndromes
– eg Falls
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3
Q

What affects balance?

A

Inputs

  • Vision
  • Vestibular
  • Joint position
  • Muscle stretch
  • Peripheral sensation

Outputs
- skeletal muscles
(joints)
- eye movements

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4
Q

What in the environment will affect balance?

A
  • Floor
  • Lighting
  • Obstacles
  • Distractions
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5
Q

How does higher function affect balance?

A
  • Intention and plan
  • Concentration
  • Memory
  • Confidence and fear
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6
Q

What is reserve?

A

Extra capacity that everyone has to cope with external stress

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7
Q

What is frailty?

A

A loss of reserve

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8
Q

What is the process of accelerated ageing?

A
  • Loss of muscle
  • Age related change
  • Illness
  • Reduced function
  • Reduced confidence
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9
Q

What happens when a frail person gets a minor illness?

A
  • Is not functionally able
  • May result in later inability to acquire functional ability
  • Longer period of recovery
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10
Q

What factors are poor outcome predictors in frailty?

A

– Age, sex, smoking status
– Comorbidities (Cardioresp, CKD, CA)
– Biomarkers (albumin, creatinine…)
– Function

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11
Q

When is a Comprehensive Geriatric Assessment (CGA) used?

A

– On inpatients in specialist units

– To high-risk (frail) outpatients

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12
Q

How do you do a Comprehensive Geriatric Assessment (CGA)?

A 
 Falls history
 Balance & Gait, mobility
 Cognition, mood and capacity
 Social situation and support (Ask who they are happy for us to talk to )
 Medication - review and consider 
 Nutrition and hydration
 Skin
 Continence & elimination
 Feet & footwear
 Sensory ( Vision, hearing, peripheral)
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13
Q

What would you look at in a medication review in a CGA?

A 
Removing unnecessary
 Antihypertensives
 Antipsychotics
 Diuretics
 Sedatives and night sedation

Adding
 Ca&Vit D
 DVT prophylaxis
 Antihypertensives per HYVET (indapamide +/- perindopril)

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14
Q

How do we look at the bigger picture?

A
  • Acute change vs progression
  • How far from baseline*?
  • Is the new problem the main problem?
  • Declining? Dying?
  • What can we achieve?
  • How can we improve QOL / independence?
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15
Q

How do you take a history with CGA in mind?

A
  1. Background (in a nutshell)
  2. Presentation
  3. Initial assessment & diagnosis
  4. Course of admission / treatment so far
  5. Current status
  6. Problems, issues, gaps, questions & revisions
  7. Plan
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16
Q

What could the causes of a fall be?

Study These Flashcards
A 
• Environmental
• Visual
• Gait
– Strength & fitness
– Pain?
– Peripheral sensory loss
• Drops in blood pressure?
• Medication?
• Acute illness?
17
Q

What is delirium?

Study These Flashcards
A
  • “Acute Confusion”
  • Inattention
  • Cognitive impairment
  • Alertness
18
Q

What is the pathophysiology for delirium?

Study These Flashcards
A
  • Poorly understood but common
  • Inflammatory cascade
  • Neurotransmitter changes
  • Hormonal (Thalamic / Pituitary / Adrenal)
  • Cellular / Intracellular
19
Q

How do you tell if a non english speaker has delirium?

Study These Flashcards
A 
– Distractible / Inattentive
– Drowsy / Hyperalert
– Picking at clothes/sheets (carphologia)
– Not getting out of bed
– Not interacting with others
– Unwell!
20
Q

What is CAM?

Study These Flashcards
A

• 1: Acute Onset
– Until proven otherwise?

• 2: Inattention
– Distractible

• 3: Disorganised thinking
– Rambling?

• 4: Altered Consciousness
– Drowsy / Hypervigilant

21
Q

What is the 4AT?

Study These Flashcards
A 
Test for delirium
4 A's
Alertness
AMT4
Attention
Acute change or fluctuating cause
22
Q

What are the consequences of delirium?

Study These Flashcards
A

– Twice as likely to die
– Twice as likely to be in institutional care
– 12 times more likely to have a dementia diagnosis

23
Q

What can cause delirium?

Study These Flashcards
A 
– Hypoxia
– Constipation
– Urinary retention
– Urosepsis
– Change of environment
– Withdrawal from sedatives / alcohol / analgesia
– Sedatives / alcohol / analgesia
– Anticholinergics*
24
Q

Why do anticholinergics cause delirium?

Study These Flashcards
A

– Cholinesterase inhibitors (Dementia drugs) increase ACh
– Many drugs have anticholinergic properties
• Bladder antispasmodics (eg oxybutynin)
• Tricyclic antidepressants (eg amitryptilline)
• Furosemide
• Digoxin
• Cyclizine

25
What is the treatment of delirium?
``` • Make the diagnosis, then consider cause(s) – Make a list! • Treat the underlying cause(s) • Also: – Supportive care – Orientation – Appropriate environment – Stop making it worse! ```
26
Why can benzo's cause delirium?
Benzo withdrawal
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