Ageing Flashcards
Difference in an MI in a young person and old person
can have no chest pain. Can get SE from stating and antiplatelets so need diff dose to a younger person
Sepsis in an old person
vasodilation rather than vasoconstriction, low temp, may not have a tachycardic response, CRP and WCC may not be high, AB targeted as higher risk of C.diff
diagnosis of sarcopenia
low muscle mass + low muscle strength/low physical performance
when does muscle mass decline
age 30, accelerates at age 60
consequences of sarcopenia
less energy used so more fat so insulin resistance and diabetes and less exercise. muscle weakness so more falls and fractures and more bone loss so again less activity. all means they have to depend on others more
interventions for sarcopenia
exercise - resistance training and strength, endurance and functional measures
nutrition - calcium, vit D, protein
creatinine
ACEi can improve muscle function
target of physical activity for >65
same as 18-64. 150 moderate exercise in bouts of 10 mins or more across the week (walking for 30 mins 5x week). or 75mins of vigorous activity.
Also want 2x of strength/balance training per week
what is habilitation
helping an individual achieve their goals
what is rehabilitation
process. whole individual. max potential to live a ful and active life
what is reablement
active process of an individual regaining the skills, confidence and independance to do things for themselves
framework for classifying and assessing health and disability
ICF
physio, occ health, speech and lang therapist
how can we measure outcome of rehabilitation
Rivermead motor assess scale - imparement/activity specific
ADL scales - Barthel index, functional independence measure
features of delerium
disturbance in attention
change in cognition
develops over a short period and fluctuates during the day
some evidence that something is underlying and causing delirium
pathophysiology of delerium
variable derangement of multiple neurotransmitters - partic ACh
direct toxic insults - drugs, hypoxia etc
abberant stress response - cortisol
what to check for in delerium
hydration, stop nephrotoxic drugs, optimise BP, perfusion, look for intrinsic renal disease, review
drugs not to use in elderly
trimethoprim, haloperidol
anticholinergics bad for the brain
if you have to give meds in delirium what do you give?
haloperidol - orally
quetiapine in parkinsons/lewy body
benzos if alcohol/benzo withdrawl or if seizure - use lorazepam but lorazepam can worsen delirium
delirium follow up
PTSD common after
higher risk of developing dementia
risk of more episodes
tests to do in someone presenting with tiredness
B12, folate, Hb, thyroid
tests to do when suspect dementia
B12, folate, FBC, thyroid
how is morphine excreted
renally
presecribing morphine
oromorph 2.5mg 2x day, 2x day long active morphine (MST) + oral immediate effect (oromorph)
prescribe a laxative too, prn antiemetic (metaclopramide - but not in parkinsons)
breakthrough dose is usually 1/6 of total daily dose - eg if patient taking 50mg bd breakthrough dose would be 15mg oramorph
in end of life care how are durgs best administered
oral often not an option so SC continuous infusion using a syringe driver is best. up to three meds can be mixed in the syringe and infused over 24 hours
how to change from oral to SC morphine
SC morphine is twice as potent as oral, so divide dose by two
what to presecribe in EOLC for pain/SOB
morphine