Flashcards in Care of the Elderly Deck (18)
Causes of falls in elderly people?
Drugs (e.g. sedatives, alcohol)
MSK (e.g. OA of hip)
Syncope (e.g. vasovagal, cardiogenic, arrhythmias)
Postural hypotension (secondary to antiHTs, hypovolaemia, dopaminergic drugs)
Vertigo (e.g. BPV, meniere’s disease)
Neuro: periph neuropathy, Parkinson’s
Poor environment (e.g. poor lighting, loose rugs)
3 main features of Parkinson's?
Rigidity (lead-pipe; cogwheel)
Differentiating features of Parkinsonian tremor?
Worse at rest
Reduced on distraction
Reduced on movement
Pathophysiology of Parkinson's?
Loss of dpominergic neurons in substantia nigra
What drug usually combines with L-dopa in Parkinson's to prevent S/E?
Dopa decarboxylase inhibitor (e.g. carbidopa or benserazide)
Complications of L-dopa therapy for Parkinson's?
Postural hypotension on starting treatment
L-dopa induced dyskinesias
On-off effect: fluctuations in motor performance between normal function (on) and restricted mobility (off).
Shortening duration of action of each dose (i.e. end-dose deterioration where dyskinesias become more prominent at the end of the duration of action)
How to calculate risk of stroke post-TIA?
Age > 60 (+1); BP >40/90 (+1); Clinical features: unilat. weakness (+2), speech disturbance w/out weakness (+2); Duration of sx: >1hr (+2), 10-59 mins (+1); Diabetes (+1)
Increased vulnerability resulting from ageing associated decline in reserve and function across multiple physiologic systems --> ability to cope with everyday/acute stressors is compromised.
What is acopia?
Medical slang - social admission. Pt's can't cope with ADLs. Hugh mortality rate because of missed path, biased against.
Don't use this term
What are geriatric giants?
The major categories of impairment in elderly people. Include immobility, instability, incontinence & impaired intellect/memory.
Impaired vision and hearing loss - common chronic probs. Hearing problems --> social isolation, depression, and dependence. Vision probs --> falls, meds being taken incorrectly cos written instructions couldn't be read, finances being mismanaged.
Complications with treatment in older people?
Much more prone to s/e, can --> red. organ func., often multiple pathologies, polypharm.
What is rehabilitation
Process of restoring a patient to maximum function. (Need to know pre-morbid function.)
Can happen in a variety of settings, in and out of hospital.
Involves MDT, including doctors.
Leads to process of discharge planning.
What are the legal/ethical issues surrounding geriatric medicine?
End of life care (fluids, feeding, abx)
MCA (decisions about treatment, discharge)
Immediate management for TIA
Aspirin (300mg daily) stat - with PPI if indicated
Specialist assessment within 1 week if suspected TIA
Long term management of TIA
Clopidogrel 75mg od
Statins, antihypertensives if necessary
Warfarin, NOACs if AF, mitral stenosis, dilated cardiomyopathy, recent big septal MI
Risk factors for pressure ulcers?
Age > 70
Paralysis (may be partial)
Med conds that affect blood supply: DM, periph artery disease, renal failure, heart failure
SCORING SYSTEM: WATERLOW
How to prevent pressure sores?
Pressure redistribution and friction reduction (e.g. special foam mattresses, heel support, cushions)
Reposition (every 6 hrs if normal risk, 4 in high)
Reg skin assessment - check for areas of pain/discomfort, skin integrity at pressure areas, colour changes, variations in heat, firmness and moisture)