What age-related differences are there medically in older people?
- Clinical findings
- Rehab
- Pathologies
- Presentations
- Homeostasis
- Immunity
- Clinical findings - may not necessarily be pathological, e.g. lung crackles
- Rehab - is more essential to return to ADLs and will take longer
- Pathologies - multiple pathologies likely
- Presentations - atypical presentations likely may present with medical problems in disguise e.g. as falls
- Homeostasis - reduced reserve e.g. CO response decreased
- Immunity - reduced, signs may not be typical e.g. no fever with infection, abdomen not rigid in peritonitis, WCC many not ↑ - hypothermia instead!
What are the geriatric giants?
Common presentations of different illnesses:
- Immobility
- Falls
- Incontinence
- Confusion / delirium
What are common sources of sepsis in older people?
- UTIs
- Chest infections
- Biliary tract infections
Define frailty
→ vulnerability to poor homeostasis after a stressor event. The result of cumulative decline over a lifetime that depletes homeostatic reserve. Minor events then lead to a disproportionate change in health status.
What are some common clinical presentations of frailty? x6
- Falls - balance and gait impairment = major features of frailty
- Hot-fall = related to a minor illness that ↓ postural balance below threshold needed to maintain proper gait
- Spontaneous fall = more severe frailty, postural systems (e.g. vision, balance, strength) aren’t sufficient to navigate undemanding environments
- Delirium (acute confusion) - characterised by rapid onset of fluctuating confusion and impaired awareness
- ~30% of elderly persons admitted to hospital develop delirium
- Fluctuating disability - day-to-day instability giving pts ‘good’ days and ‘bad’ days where professional help is needed
- Sarcopenia (loss of muscle mass + strength due to ageing)
- Osteoporosis
- Non-specific: extreme fatigue, unexplained weight-loss, frequent infections
What are the 2 types of fall?
- Hot-fall = related to a minor illness that ↓ postural balance below threshold needed to maintain proper gait
- Spontaneous fall = more severe frailty, postural systems (e.g. vision, balance, strength) aren’t sufficient to navigate undemanding environment, often present repeatedly and are associated with a fear of furhter falls
What 7 aspects are assessed as part of a ‘comprehensive geriatric assessment’?
- Medical diagnoses
- Review of medication
- Social circumstances
- Assessment of cognition and mood
- Functional ability - deficits in intrumental activitys of daily living (IADLs: banking, transportation, cooking, cleaning, shopping) or basic activites of daily living (BADLs: feeding, bathing, dressing, toileting)
- Environmental assessment
- Economic circumstances
What are Instrumental activities of daily living? IADLs
IADLs: banking, transportation, cooking, cleaning, shopping
What are basic ADLs? BADLS
feeding, bathing, dressing, toileting
What are the 5 symptoms in Fried’s frailty phenotype (3 or more of which have to present for someone to be labelled ‘frail’)?
3 or more of the following:
- Walking speed - appear in slowest 20% by gender and height
- Measure: timed 15 foot (5 metre) walk
- Grip strength - weakest 20% by gender and BMI
- Measure: dynanometer
- Weight loss - loss of 10 lbs (4.5kg) in the past year
- Measure: self report
- Fatigue - self reported “trouble getting going”
- Activity level - lowest 20% (males: 383 kcals/week, females: 270 kcals/week)
- Measure: self report no. of calories expended
In elderly pts who can provide a history, what is required to diagnose UTI?
NOT a urine dipstick!
Only diagnose in the presence of at least 3 acute urinary symptoms:
- Dysuria
- Urgency
- Frequency
- Suprapubic tenderness
What is the POSITIVE predicitive value of urine dipsticks in elderly pts?
Positive predictive value of dipstick = rubbish (“might as well toss a coin”)
- Asymptomatic bacteriuria is common in older people
- Only a -ve result is considered useful as it eliminates UTI
- Give antibiotics for UTI in elderly if:
- Pts have acute urinary symptoms
- or have bacteriuria and evidence of systemic inflammation (fever / ↑ inflammatory markers)
- without another more likely source of infection
What are the 4 categories of Risk Factors for Elder Abuse?
What is in each category?
- Factors relating to the older (abused) person
- Cognitive impairment
- Shared living
- Functional dependency
- Low income
- Factors relating to the perpetrator
- Psychiatric illness (including dementia)
- Drug and alcohol dependency
- Caregiver burden and stress
- Relationship factors between perpetrator and abused
- Family disharmony
- Conflicted relationships
- Environmental factors
- Low social support
- Shared living
