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Year 3 > Ageing > Flashcards

Ageing Flashcards

(48 cards)

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1
Q

4 components of a comprehensive geriatric assessment?

A

Medical
Functioning
Psychological
Social/Environment

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2
Q

Why is acute illness in elderly likely to present in an atypical manner?

A

Co-morbidities

Impaired immune/physiological functioning

Polypharmacy

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3
Q

Criteria for sarcopenia?

A

Low muscle mass

+ 1/2 of:
Low muscle strength
Low physical performance

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4
Q

Sarcopenic obesity?

A

Loss of muscle mass with increased fat - BMI may remain the same

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5
Q

Interventions for sarcopenia?

A

Exercise - progressive resistance training and aerobic training

Reduce sedentary time

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6
Q

Rehabilitation?

Reablement?

A

Rehab - disabled by injury/disease achieve a full recovery

rebate - poor physical/mental health re-learn skills to accommodate illness

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7
Q

3 things which contribute to ageing?

A
  • Random molecular damage during cell multiplication
  • Inactivity, poor diet, inflammation etc
  • Reduced ability of body’s adaptive reserve capacity (resilience)
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8
Q

3 things frailty causes?

A

Loss of homeostasis and resilience

Increased vulnerability to decompensation after a stressor event

Increased risk of falls, delirium, disability, death

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9
Q

Any sudden decline in health?

Multimorbidity?

A

Due to disease

Higher rates of adverse events and poorer QOL

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10
Q 
Palliative care:
Pain/SOB?
Distress?
Nausea/agitation?
Res secretions?
A

Pain/SOB - morphine

Distress - midazolam

Nausea/agitation - Levomepromazine

Res secretions - Buscopan

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11
Q

AF increases stroke risk how much?

A

5x

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12
Q

Cardioembolic stroke?

Atheroembolic stroke?

A

Cardio - fibrin rich red thrombus - anticoagulant

Athero - platelet rich white thrombus - anti-platelet

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13
Q

Frontal lobe functions?

Lesion?

A

Function - personality, emotional response, social behaviour

Lesion - disinhibition, lack of initiative, antisocial behaviour, incontinence, impaired memory, grasp reflex, anosmia

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14
Q

Dominant parietal function?

Lesion?

A

Fun - calculation, language, planned movement, appreciation of size/shape/weight/texture (stereognosis)

Lesion - dyscalculia, apraxia, AGNOSIA, homonymous hemianopia - L/R DISORIENTATION

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15
Q

Non-dominant parietal function?

Lesion?

A

Function - spatial orientation, construction skills

Lesion - HEMISPATIAL NEGLECT, construction/dressing apraxia, homonymous hemianopia

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16
Q

Occipital function?

Lesion?

A

Function - Analysis of vision

Lesion - homonymous hemianopia with MACULAR SPARING, impaired facial recognition, visual hallucinations

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17
Q

Dominant temporal function?

Lesion?

A

Function - Auditory perception, speech, language, verbal memory, smell

Lesion - Wernicke’s dysphasia, dyslexia, homonymous hemianopia, poor memory, complex hallucinations (sound, smell, vision)

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18
Q

Non-dominant temporal function?

Lesion?

A

Function - auditory perception, music, tone sequences, non-verbal memory (faces, shapes, music), smell

Lesion - homonymous hemianopia, poor non-verbal memory, loss of music skills, complex hallucinations (visual, smell, sound)

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19
Q

Is delirium acute?

A

Yes

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20
Q

4 hallmark symptoms of delirium?

Study These Flashcards
A

1 - acute and fluctuating
2 - inattention
3 - altered consciousness
4 - disorganised thinking

21
Q

Hyperactive delirium?

Hypoactive delirium?

Study These Flashcards
A

Hyper - agitated, aggressive, wandering

Hypo - withdrawn, apathetic, sleepy (coma)
–> easily missed, 2x higher mortality

22
Q

2 Ix for delirium?

Study These Flashcards
A 
4AT:
Alertness
AMT4 (age, DOB, place, year)
Attention (months of year backwards)
Acute/fluctuating course

CAM:

  1. acute/fluctuating
  2. Inattention
  3. Disorganised thinking
  4. Altered consciousness
    - -> 1 and 2 + 3 OR 4
23
Q

Conservative management of delirium?

Study These Flashcards
A

Environment and supportive factors

Identify and treat underlying cause

Symptom control

24
Q

Medical management of Delirium?

Study These Flashcards
A

Haloperidol - NOT IN PARKINSONS

Quetiapine - in Parkinsons/Lewy Body Dementia

Benzo - alcohol/benzo withdrawal or seizure (Lorazepam or Chlordiazepoxide) - however beware these can worsen delirium

25
Predisposing factors for delirium?
- Age - Pre-existing dementia - Co-morbidity - Terminal illness - Sensory impairment - Polypharmacy - Depression - Alcohol dependency - Malnutrition
26
5 things that link falls and immobilisation?
``` Hypothermia/Dehydration Pressure sores Rhabdomyolysis VTE Bronchopneumonia ```
27
5 physiological changes in ageing that can lead to falls?
- Central processing/cognition (reduced reaction) - Vision (smaller pupil, thicker lens) - Sarcopenia (less muscle mass and function) - Peripheral sensation/proprioception (increased postural sway and poor sensory awareness) - Reduced activity (decreased cardio fitness)
28
Risk factors for falls? | CVS, central processing, MSK, neuro, vision, other
CVS - dizziness, postural hypotension, heart disease Central processing - cognitive impairment, depression MSK - pain, arthritis, sarcopenia Neuro - parkinsonism, stroke, neuropathy, balance Vision - acuity, depth perception, contrast sensitivity Other - low BMI, Hx of falls, age>80, female
29
What is postural hypotension?
Drop of >20/10mmHg on standing after 2 mins
30
8 Drug classes that increase fall risk?
- Benzos - Neuroleptics - Antihypertensives - Antidepressants (SSRI hyponatraemia, TCA antivholinergic) - Anticholinergics - Class 1a anti-arrhythmatics (disopyramide) - Diuretics - anti-epileptics
31
Investigations for falls?
- HR, Cardio, postural BP - Visual acuity - Gait, balance, joints
32
3 Assessment tools for falls?
Timed get up and go Berg Balance Test (Balance only - static and dynamic balance) Tinetti Score (Balance AND Gait) - performance orientated mobility assessment (POMA)
33
Management of falls? (5)
- Risk modification - Strength and balance training - Vision optimisation - Footwear and foot care - Osteoporosis treatment
34
2 principles of drug absorption?
1 - acidic drugs need acidic environment (e.g. Phenytoin, Aspirin, Penicillin) 2 - Basic drugs need basic environment (e.g. diazepam, morphine, pethidine)
35
Pharmacodynamics in elderly?
Lower dose achieves same effect (e.g. alcohol) However effects of some drugs are decreased (e.g. B-blockers and HR)
36
SE of amlodipine?
oedema (treat with furosemide)
37
SE of NSAIDs?
hypertension GI bleeding decline of GFR Treat GI with H2 blockers, which can lead to delirium (from tiredness), which needs treated with haloperidol
38
SE of metoclopramide?
parkinsonism (treat with sinemet (carbidopa/levodopa))
39
SE of thiazides?
Gout (tread with NSAIDS, which may then require 2nd anti-hypertensive added)
40
SE of sedafed? | pseudoephedrine - sympathomimetic, used as nasal decongestant
Urinary retention (then need alpha blockers)
41
10 most common drugs likely to cause SE in elderly?
``` Warfarin Digoxin Insulin Benzos Diuretics NSAIDs Corticosteroids Anti-hypertensives Opioids (confusion, falls) Theophylline (insomnia, diarrhoea, irritability, headache, incontinence) ```
42
Why do elderly absorb basic drugs more readily?
1 - less acid production therefore increased stomach pH 2 - Acidic drugs bind albumin and Basic drugs bind A1-AG - elderly have low albumin and high A1-AG
43
Difference of lipophilic drugs in elderly?
Elderly have higher volume distribution (Vd) of lipophilic drugs
44
Grapefruit juice?
Interacts with simvastatin - CYP450 inhibition by grapefruit juice - myalgia
45
Cranberry juice?
Warfarin - increases INR - bleeding risk
46
4 things in pharmacokinetics?
ADME Absorption Distribution Metabolism Excretion
47
How to manage side effects?
Try changing to another drug - avoid treating SE with more drugs if possible
48
Therapeutic index?
Minimum toxic dose/minimum effective conc

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