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Flashcards in Care of the Elderly Deck (18)
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1

Causes of falls in elderly people?

Drugs (e.g. sedatives, alcohol)
MSK (e.g. OA of hip)
Syncope (e.g. vasovagal, cardiogenic, arrhythmias)
Stroke/TIA
Postural hypotension (secondary to antiHTs, hypovolaemia, dopaminergic drugs)
Vertigo (e.g. BPV, meniere’s disease)
Neuro: periph neuropathy, Parkinson’s
Hypoglycaemia
Poor environment (e.g. poor lighting, loose rugs)
Visual impairment
Dementia

2

3 main features of Parkinson's?

Tremor
Bradykinesia
Rigidity (lead-pipe; cogwheel)

3

Differentiating features of Parkinsonian tremor?

Slow (pill-rolling)
Worse at rest
Asymmetrical
Reduced on distraction
Reduced on movement

4

Pathophysiology of Parkinson's?

Loss of dpominergic neurons in substantia nigra

5

What drug usually combines with L-dopa in Parkinson's to prevent S/E?

Dopa decarboxylase inhibitor (e.g. carbidopa or benserazide)

6

Complications of L-dopa therapy for Parkinson's?

Postural hypotension on starting treatment
Confusion, hallucinations
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)

7

How to calculate risk of stroke post-TIA?

ABCD2 Risk
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)

8

Define frailty

Increased vulnerability resulting from ageing associated decline in reserve and function across multiple physiologic systems --> ability to cope with everyday/acute stressors is compromised.

9

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

10

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.

11

Complications with treatment in older people?

Much more prone to s/e, can --> red. organ func., often multiple pathologies, polypharm.

12

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.

13

What are the legal/ethical issues surrounding geriatric medicine?

End of life care (fluids, feeding, abx)
MCA (decisions about treatment, discharge)
Dementia/delirium

14

Immediate management for TIA

ABCDE assessment
Aspirin (300mg daily) stat - with PPI if indicated
Specialist assessment within 1 week if suspected TIA

15

Long term management of TIA

Lifestyle modification
Clopidogrel 75mg od
Statins, antihypertensives if necessary
Warfarin, NOACs if AF, mitral stenosis, dilated cardiomyopathy, recent big septal MI

16

Risk factors for pressure ulcers?

Age > 70
Being bedridden
Paralysis (may be partial)
Obesity
Urinary/bowel incontinence
Poor nutrition
Med conds that affect blood supply: DM, periph artery disease, renal failure, heart failure
SCORING SYSTEM: WATERLOW

17

How to prevent pressure sores?

Barrier creams
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)

18

4 cardiac conditions that may cause embolic CVA?

AF
MI causing mural thrombus
Infective endocarditis
Aortic/mitral valve disease
Patent foramen ovale