ageing Flashcards
(37 cards)
State the main components that comprise the CGA?
Medical (Problem list, co-morbidities, medication review, nutritional status)
Functioning (Basic and extended ADLs, activity status, gait and balance)
Psychological (mental status, mood testing)
Social/ environment (Informal needs, social circle, care eligibility, safety)
State what delirium encompasses (AAID)
altered level of consciousness
Acute and fluctuating
inattention
disorganised thinking
What are the two broad categories of delirium?
Hypoactive (drowsy, reduced consciousness, withdrawn, apathetic, sleepy, coma increased risk of pressure sores) 2x mortality
Hyperactive (agitated, aggressive, wandering increased falls risk)
Suggest two tools that can be used to assess the risk of the patient having delirium
4AT + CAM
componenets of 4AT
- alertness
- AMT4 (age, DOB, place, current year)
- attention (months backward)
- acute of fluctuating course
What dual medication therapy commonly used in UTIs should be avoided in a possible delirium
Trimethoprim and haloperidol
Why might you want to stop co-codamol in a patient with possible delirium and pain that isn’t too severe?
It can precipitate her delirium and codeine can be constipating
Why might you want to stop Bendroflumethiazide?
low Bp and cause falls
Scoring system for determining if there has been a stroke
ROSIER score
3 subcategories of stroke
Haemorrhage, Infarct, SAH
stroke symptoms Less than 24 hours =
TIA
Medications used in secondary prevention of stroke
Anticoagulants if cardioembolic/ AF Antiplatelets if not cardioembolic (first line Clopidogrel) Stop smoking Statins Manage blood pressure Diet and lifestyle advice
CHADSVASC score
Congestive HF Hypertension Age >75 - 2 Diabetes Stroke/TIA/thromboembolism - 2 Vascular disease Age 65-74 Sex Category - Female
If CHADSVASC greater than 1 then recommend
Warfarin/NOAC
What scoring system is used to weigh up the risk of bleeding on anticoagulants?
HASBLED - It assesses 1-year risk of majorbleedingin patients taking anticoagulants with atrial fibrillation
Which type of ischaemic stroke should not be treated with aspirin?
Cardioembolic (fibrin rich > anticoagulant required)
worse prognosis stroke =
TACI
how are telomeres the biological marker of ageing?
They progressively shorten with each cell replication, and eventually become too short to sustain cell replications (then leading to cell senescence) shorter telomeres = shorter life expectancy
What is meant by ‘frailty’?
Loss of homeostasis and resilience
Increased vulnerability to decompensation after a stressor event
Increased risk of falls, delirium, disability, death
What physiological factors increase risk of falls in elderly?
- vision: smaller pupils, lens thickening = ↓light
- central processing and cognition = ↓reaction time
- ↓cardiorespiratory fitness
- sarcopenia (loss of muscle mass and function)
- ↓peripheral sensation and proprioception, ↑postural sway
causes of falls and syncope in elderly
Arrythmias Orthostatic hypotension Neurogenic (vasovagal) Carotid sinus hypersensitivity Valvular heart disease (Aortic stenosis)
orthostatic hypotension is defined as
a fall in SBP >20mmHg or a fall in DBP >10mmHg after 3 minutes of standing
how does cervical myelopathy present?
High stepping gait
+ve romberg test
how does peripheral neuropathy present?
altered sensation
wide-based gait
