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PAR3032 - Special Populations > Week 3 > Flashcards

Week 3 Flashcards

1
Q

What s frailty?

A

Defined as a medical syndrome:

  • multiple cause and contributors
  • diminished strength and endurance
  • reduced physiological function
  • Increase an individual’s vulnerability
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2
Q

What are the stages of the clinical frailty scale?

A
  1. Very fit
  2. Well
  3. Managing well
  4. Vulnerable
  5. Mildly frail
  6. Moderately frail
  7. Severely frail
  8. Very severely frail
  9. Terminally ill
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3
Q

What are the challenges faced with frail patients?

A

• Multiple Diagnoses, some long-term, some acute

• Presentations with non-specific S&S
- Underlying pathology not obvious

  • Complexity of Hx taking and physical examination
  • ^prevalence of mental, function and social issues
  • Polypharmacy
  • ^vulnerability to, poor recovery from, stressor events
  • Balancing between quality and quantity of life (ethical considerations)
  • ^prevalence of cognitive dysfunction
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4
Q

What are some assessment limitations with frail patients?

A
  • Multiple symptoms
  • Multiple Co-morbidities
  • Polypharmacy
  • Sensory Impairment
  • Cognitive Impairment
  • Social and environmental limitations that impact upon their health
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5
Q

What should you consider when assessing frail patients?

A
  • Cognitive State (vs Pt’s normal)
  • Nutritional State
  • Sensory Impairment (PHx of neuro event?)
  • Musculoskeletal issues and gait
  • Pressure Area
  • Postural BP
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6
Q

What happens in regards to fat composition with ageing?

A

Increased Fat composition, more centrally distributed

- ^ Waist Circumference

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7
Q

What happens with body water content in regards to ageing?

A

Decreased total body water

- Intracellular fluid loss

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8
Q

What happens with bone and muscle mass with ageing?

A

Decreased Bone and Muscle Mass

  • Bone mass peaks at 25-30
  • Atrophy, Hormonal changes, Neuronal degeneration, Impaired protein synthesis
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9
Q

What happens with immune function with ageing?

A

Decreased immune function:

  • B-cell numbers are preserved, but decreased specific antibody and increased autoantibody production
  • T-Cell numbers are decreased, reduced activation in respond to both new and recognized antigens
  • Decreased seroconversion and seroprotection rates following vaccination
  • 20-30% of older patients have a diminished febrile response to infection
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10
Q

What happens with vessel wall compliance with ageing?

A

Reduced vessel wall compliance:
- Reduced elastin, increased collagen and calcium deposit

  • Endothelium is less responsive to vasoactive substances
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11
Q

WHat happens to BP with ageing?

A

Reduced ability to maintain BP

- Decreased baroreceptor sensitivity

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12
Q

What happens with cardiac function with ageing?

A

Reduced cardiac function

  • Decreased elastin and increased collagen and calcium deposition > impairs diastolic relaxation
  • Resting HR and CO remain stable, but peak HR and EF decline
  • Heart valve undergo sclerosis due to calcification
  • Conduction system undergo fibrosis and fatty change with predisposition to arrthymias
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13
Q

What happens with lung compliance with ageing?

A

Reduced lung compliance

- Reduced elastic recoil of lung, decreased respiratory muscle strength

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14
Q

What hasppens with renal function with ageing?

A

Reduced renal function

  • Loss of renal mass after age of 40
  • Mostly in the cortex, with loss of nephrons
  • Thickening of basement membrane
  • Increased renal artery resistance > reduced kidney blood flow
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15
Q

WHat happens wth GI suystem wth ageing?

A

More likely to have GI problems

  • Reduced oesophageal motility > impaired swallowing + GORD
  • Weakened connective tissue within colonic mucosa > formation of diverticula
  • Change in prostaglandin levels and chronic Helicobacter pylori infection > Atrophic Gastritis
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16
Q

Define polypharmacy?

A

• Being prescribed with 5 or more medications

- > 1/3 of geriatric populations affected

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17
Q

what are some issues around polypharmacy in elderly?

A
  • Risk of inappropriate prescribing
  • Dose, duration, contra-indicated drugs, etc
  • ↑ Risk of side-effects
  • ↑ drug-drug interactions and risk of Adverse Drug Reactions (ADR)
  • Higher prevalence of chronic disease
  • Most drug researches based on young healthy individuals
  • Do not have multiple comorbidity or polypharmacy
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18
Q

What is osteoperosis?

A

Progressive loss of bone mass

Common – 1/3 of women over 50 YO (post menopause) would sustain a osteoporotic #
• Shift towards bone resorption
- Reduction of net bone mass

Associate with excess morbidity and mortality
• 33% die and 35% require help to walk one year after hip#

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19
Q

What are risk factors for osteoperosis?

A 
Female
Previous fragility #
Maternal Hx of Hip#
Current Smoker
ETOH ( >3 units/day)
Glucocorticoid (>3 months @ dosage >5mg D)
Low Calcium + Vit D deficiency
Low BMI
20
Q

Osteoperosis can be secondary to which diseases?

A 
RA
Hyperthyroidism, para-hyperthyroidism
Premature Menopause (<45YO)
Chronic malnutrition, malabsorption (e.g. Coeliac)
Chronic Liver Disease
21
Q

What are the categories of Dizziness and syncope with geriatrics?

A 
Vertigo
Presyncopal
Unsteady
Psychogenic
Mixed
22
Q

WHat is syncopy?

A
  • Transient LOC due to transient global cerebral hypoperfusion
  • Rapid Onset
  • Short Duration
  • Complete Recovery
  • More common in geriatrics
  • Men are more likely to have cardiac cause syncope
23
Q

What are some differental diagnosis for syncope?

A

• Epilepsy
• Metabolic Disorders (e.g. hypoxia, hypoglycaemia)
• Intoxication
• Vertebrobasilar TIA
• Cataplexy
- Sudden and uncontrollable muscle weakness / paralysis
- Often triggered by strong emotion

  • Drop attacks
  • Falls
  • Psychogenic pseudosyncope
24
Q

What is parkinsonism?

A 
Parkinsonism is a clinical syndrome characterized by:
Bradykinesia (slow movement)
Rigidity
Tremor
Hypomimia (expressionless face)
Abnormal gait
25
Q

WHat are the types of parkinsonism?

A 
Idiopathic Parkinsons disease
Vascular parkinsonism
Drug-induced parkinsonism
Lewy body dementia
Progressive supranucular palsy
Multi-system atrophy
26
Q

What is dementia?

A

Impairment of memory and other higher cortical process

Progressive (usually irreversible)

27
Q

WHat are the classifications of dementia?

A 
Alzheimers disease
Vascular dementia
Mixed dementia
Other subtypes:
- Lewy body
frontotemporal
huntingdons
alcohol-related
progressive supranuclear
28
Q

What is alzheimers

A
  • Most common (62%)

* Caused by brain degeneration

29
Q

What is vascular dementia

A
  • Second most common (17%)
  • Problem with cerebral blood supply
  • Could be further subtyped
30
Q

WHat is delerium?

A

State of mental confusion that develops quickly, usually fluctuates in intensity

Pathology still poorly understood
• Acetylcholine inhibition or pro-inflammatory cytokines may play a role
• Exacerbated by intercurrent illness or metabolic disturbance

31
Q

WHat defines delirium in the DSM IV?

A
  • Disturbance of consciousness, reduced ability to focus or shift attention
  • Changes in cognition or development of perceptual disturbance
  • Disturbance develops over a short period of time and fluctuates over the course of the day
  • Hx supports an underlying condition, medication withdrawal or intoxication
32
Q

What is a stroke?

A

Interruption of cerebral blood supply
• Haemorrhagic
• Ischemic

Clinical syndrome of focal neurological deficit of presumed vascular origin

Sudden Onset

Last for > 24 hours

33
Q

What is a TIA?

A

“Mini-Stroke”

Temporary interruption of cerebral blood supply due to blood clot

Symptoms last for < 24 hrs
• Most resolved within minutes

34
Q

What is urinary incontinence?

A

Common but underdiagnosed and poorly managed

Females are twice likely affected
• Chronic UTI?

35% of community-dwelling over-65YO

More common in care-home residents
^risk of UTIs

35
Q

What is hypertension an important risk factor for?

A
  • Cardiovascular Disease
  • Cerebral Vascular Disease
  • Renal Disease

Could be secondary to kidney and liver issues

36
Q

What are common hypertension medications?

A

Betablockers
• Metoprolol, Atenolol

ACE-Inhibitors
• Perindopril, Ramipril

Calcium Channel Blockers
• Amlodipine, Felodipine

Angiotensin Receptor Blockers
• Candesartan, Irbesartan

37
Q

WHat is heart failure?

A

Cardiac output reduced > insufficient to perfusion needs

Various types

Could be secondary to ACS
• Cardiac Remodelling

Could cause arrhythmias
• A.I.C.D.? P.P.M.?

38
Q

What is ejection fraction and the various grades for it?

A

The amount of blood that LV pumps out with each contractions

• Measurement in percentage
Grade 1: >60%
Grade 2: 40-59%
Grade 3: 20-39%
Grade 4: <20%
39
Q

What is olliguria?

A

Low urine output

According to RIFLE (Risk, Injury, Failure, Loss, and End-Stage Renal Failure)
• <0.5ml/kg/hr for more than 6/24 at a time (high risk AKI)
• <0.5ml/kg/hr for more than 12/24 at a time (positive risk AKI)
• <0.3ml/kg/hr for more than 24/24 at a time (acute renal failure)

40
Q

What is elder abuse?

A

A single or repeated act or lack of inappropriate action

• Causes harm or distress to an elderly
An elderly is deliberately harmed, mistreated, exploited or neglected

Can take place in a person’s own home or in an institution

41
Q

What are the risk factors for elder abuse?

A
  • Disability
  • Dementia
  • Cultural background (Gender inequalities)
  • Financial dependence (either the abused or abuser)
  • Quality of relationship before the disability
  • Backgrounds where violence is tolerated
  • Cohabitation
  • Poverty and lack of social inclusion
  • Carer with Hx of violence, substance misuse or mental health problems
42
Q

What are the types of elder abuse?

A 
Physical
Financial
Psychological
Neglect
Sexual
Discrimination
Institutional
43
Q

What is idiopathic parkinsons disease?

A
  • unilateral onset
  • upper limb predominance
  • treatment responsive
  • presenting with bradykinesia
44
Q

What is vascular parkinsonism disease?

A
  • lower limb predominance
  • bilateral onset
  • presentation with falls and gait problems
45
Q

What is lewy body dementia?

A

prominent cognitive impairment presenting at teh same time as parkinsonism

  • prominent hallucinations
  • fluctuations in level of consciosuness

PAR3032 - Special Populations (13 decks)

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