Ageing Flashcards by Louise Dodds

How does the ageing process affect muscles?

Decreased muscle mass
Decreased body water
Increased fat

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What is sarcopenia?

Degenerative loss of muscle mass, quality and strength associated with ageing

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What changes does ageing have on the brain?

Decreased cerebral blood flow
Autoregulation becomes defective
Decreased brain weight

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What changes does ageing have on the autonomic system?

Less reactive, especially BP and temperature

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What effects does ageing have on bones and joints?

Gradual progressive loss of bone from age 35

Osteoarthritis

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What effects does ageing have on the heart?

Decreased CO
Decreased maximal HR
Decreased SV
Calcification of valves
Ventricle hypertrophy

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What effects does ageing have on the lungs?

Decreased lung capacity
Decreased vital capacity
Decreased chest wall compliance

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What effects does ageing have on the GI system?

Decreased taste
Decreased large bowel motility
Dentures

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What effects does ageing have on eyes and ears?

Decreased function of both (presbyopia, presbyacusis)

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How does ageing affect the skin?

Becomes thinner and dryer

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How does ageing affect sleep?

Sleep becomes lighter, shorter and more broken

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What is frailty?

Loss of biological reserves across multiple body systems, resulting in increased vulnerability to relatively minor events leading to adverse outcomes

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What investigations can you do for frailty?

Comprehensive Geriatric Assessment
Timed Up and Go Test
PRISMA 7 questionnaire
Edmonton & Rockwood fraility examination

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Who falls more - women or men?

Women

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What is polypharmacy?

4 or more medications

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What are some common drugs that cause falls?

Benzodiazepines, neuroleptics, antidepressants, antihypertensives, opiates, anticholinergics, diuretics

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What are some age related causes of falls?

Postural instability due to loss of muscle mass
Postural hypotension due to loss of autonomic drive
Decreased vision - smaller pupils, glasses
Bladder instability
Decreased cardiorespiratory fitness
Decreased peripheral sensation and proprioception
Decreased reaction times

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What are cardiac causes of falls?

Arrhythmias, orthostatic hypotension, vasovagal attacks, carotid sinus hypersensitivity

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What are neurological causes of falls?

Peripheral neuropathy, spinal stenosis, stroke, Parkinsons

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What are vestibular causes of falls?

Vertigo and dizziness

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What are cognitive causes of falls?

Dementia

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What are some environmental causes of falls?

Trip hazards, stairs with no handrails, no walking aids, alcohol, inappropriate footwear

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What is a good structure to take a falls history?

BEFORE the fall, DURING the fall, AFTER the fall

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What are important questions to ask in a history about before the fall?

What patient was doing immediately before and 30 minutes prior, how they had felt over the previous few days.
Did they feel unwell/have any warning symptoms

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What are important questions to ask in a history during the fall?

Any loss of conciousness? Aware of any immediate injuries? How long were they lying for?

What are important questions to ask in a history about after the fall?

How they managed to get up, what injuries they have sustained, how they feel now (confidence etc)

What other questions are important to ask about in a falls history?

Have they fallen before? How many times? Any serious consequences? Ask about mood and consequences of these falls. Ask about mobility and bones.

What are important examinations to perform in someone who has had a fall?

``` Full physical assessment with focus on cardio&neuro examinations. Remember to check feet and footwear Check cognition Assess gait and balance Do sitting and standing BP ```

What is the best management of a fall?

Strength and balance training (3 times/week for 12 weeks) Conservative management Medication review

What other conservative management options are there for preventing a fall?

Modify home environment Ensure well fitting shoes Vision optimisation

What should a medication review do in a patient who has fallen?

Focus on only keeping drugs that are needed for symptom control Consider de-prescribing and non-drug alternatives

What is osteoporosis?

Loss of bone density resulting in thin bones with normal mineralisation

What are causes of osteoporosis?

Failure to achieve maximal bone density by 35 Hyperthyroid, hyperparathyroid, cushings, anorexia, coeliac, IBD, pancreatitis, poor calcium intake, inactivity, drugs, family history

How does osteoporosis present?

Fragility fractures, loss of height, Dowagers hump

What investigations are done for osteoporosis?

Routine bloods TFTs Myeloma screen Dexa scan

What T score is indicative of osteoporosis?

Less than -2.5

What T score is indicative of osteopenia?

1 to -2.5

How is osteoporosis treated?

Calcium + vitamin D and oral bisphosphonate | Accrete D3 + Alendronate

How do bisphosphonates work?

Inhibit osteoclasts

How are bisphosphonates taken?

Taken once a week in the morning on an empty stomach with 200mls of water. Sit up for 30 mins after taking

What is the main serious side effect of bisphosphonates?

Osteonecrosis of the jaw

What is delirium?

An acute confusional state characterised by a disturbance in attention and a change in cognition that develops over a short period and fluctuates during the episode

How does hyperactive delirium present?

Agitation, aggression, wandering

How does hypoactive delirium present?

Withdrawn, apathetic, sleepy coma

Is hyper or hypo active delirium more common?

Hypoactive

What factors predispose to delirium?

Advanced age, pre-exisiting dementia, co-morbidity, post-op, terminal illness, sensory impairment, polypharmacy, depression, alcohol, dependency, malnutrition

What factors precipitate delirium?

UTI, dehydration, constipation, alcohol, fractures, hyponatraemia, drugs, chest infections, hospital

What are the hallmarks of delirium to look out for?

Acute and fluctuating course Inattention Altered cognition Disorganised thinking

What are the 4 areas of the 4AT?

Alertness AMT4 Attenton Acute/fluctuating

How is alertness assessed in 4AT?

Normal/sleepy = 0 points | Abnormal = 4 points

How is AMT4 assessed in 4AT?

Ask patients age, DOB, current place, current year No mistake = 0 points 1 mistake = 1 point 2 or more mistakes = 2 points

How is attention assessed in 4AT?

Ask patient to say the months of the year backwards 7 or more = 0 Less than 7 = 1 Untestable = 2

How is acute/fluctuating scored in the 4AT?

``` No = 0 points Yes = 4 points ```

What score in the 4AT is suggestive of possible delirium?

4 or more

What conservative management options are important in delirium?

``` Continuity of staff/familiar people Quiet/calm environment with low lighting (sideroom) Visible clock with place and date also Engage and reassure relatives Work to identify an underlying cause ```

What legal framework would be used if there was concerns regarding capacity?

Adults with Incapacity Act Section 47

When is sedation used in delirium?

If the patient is a danger to themselves or others

What sedation is used in delirium?

Haloperidol (0.25-0.5mg) orally. Max 5g in 24 hours

What sedation is used in patients unable to have haloperidol (e.g. Parkinsons)?

Lorazepam

Who should follow up patients who have had delirium?

Psychiatry of old age team

What is an episode of delirium a risk factor for?

Dementia and further episodes of delirium

What do potassium rich foods like bananas, oranges and green leafy vegetables interact with?

ACE inhibitors, ARBS, spironolactone

What food does warfarin interact with?

Apples, chickpeas, spinach, nuts, kiwi, broccoli (Vitamins E and K)

What do chicken, turkey, milk, soy (foods that alter pH) interact with?

Antibiotics, digoxin, diuretics

What drugs do grapefruit, apple, orange and cranberry (Cytochromone P450) interact with?

Statins | Antihistamines

What drugs most commonly precipitate delirium?

Sedatives, hypnotics, antidepressants, levodopa, codeine, digoxin, furosemide, oxybutynin

What is refeeding syndrome caused by?

Malnourished/ill patients becoming unwell due to an inappropriately high protein-calorie intake

Patients with what MUST score should be referred to the dieticians?

More than 2

How many hyperthyroidism present in the elderly?

Apathy, tiredness, muscle weakness, loss of appetite, weight loss

What is posutral hypotension defined as?

Fall of >20mmHg systolic or >10mmHg diastolic upon standing

What is the aetiology of essential tremor?

Inherited or lead/manganese exposure

What are the characteristics of essential tremor?

6-12hZ and postural

How is essential tremor treated?

Propranolol