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Flashcards in Care of the Elderly Deck (115)
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1

define frailty

state of increased vulnerability resulting from ageing associated decline in reserve and function across multiple physiological systems such that ability to cope with everyday or acute stressors is compromised

key bits is they have a poor functional reserve, so they're really vulnerable to decompensation when faced with illness, drug side-effects or metabolic disturbances

2

what are some common co-morbidities seen in the elderly?

linked - lung cancer, COPD, peripheral vascular disease (smoking causes all)
unlinked:
- diabetes
- dementia
- myeloma

PNEUMONIA - often seen on top of all of these!

3

what are the most common causes of geriatric admission?

falls
confusion
incontinence
'off legs'
social admission
chest pain, SOB, urinary symptoms

4

what are the 4 geriatric giants (Is)?

Instability (falls)
Immobility (off legs)
Intellectual impairment (confusion)
Incontinence

5

what are the 5 Ms of geriatrics?

Mind:
- dementia
- delirium
- depression
Mobility:
- impaired gait and balance
- falls
Medications:
- polypharmacy
- deprescribing/optimal prescribing
- adverse effects
- medication burden
Multi-complexity
- mutli-morbidity
- biopsychosocial situations
Matters most
- individual meaningful health outcomes and preferences

6

what is acopia?

term for "social admission" - negative connotations - DON'T use.
used to describe pts unable to cope with ADLs.

beware serious underlying pathologies that can easily be missed.

7

what is deconditioning?

occurs after a patient has been bedbound for days/weeks when admitted to hospital
they're confused.
poor nutritional state (often present even prior to admission), made worse by acute illness.
can't walk, falls, can't look after themselves.
need a lot more than just meds!

8

what is involved in a comprehensive geriatric assessment?

it's a multidimensional, multidisciplinary diagnostic process
determines frail older person's medical, psychological and functional capacity.
tries to develop coordinated, integrated plan for treatment and long term follow up.

9

what are the four areas of a comprehensive geriatric assessment (CGA)? who might contribute to assessment of each category?

medical assessment - drs, nurse, pharmacist, dietician, SaLT
functional assessment - OT, PT, SaLT
psychological assessment - dr, nurse, OT, psychologist
social and environmental assessment - OT, social worker

10

what is included in the medical assessment as part of the CGA?

problem list
co-morbid conditions and disease severity
medication review
nutritional status

11

what is included in the functional assessment as part of the CGA?

ADLs
activity/exercise status
gait and balance

12

what is included in the psychological assessment as part of the CGA?

cognitive status testing
depression/mood screening

13

what is included in the social/environmental assessment as part of the CGA?

informal support needs and assets
eligibility/need for carers
home safety

14

what are the activities of daily living (ADLs)?

- mobility - ask about aids, appliances etc, stairs?
- washing and dressing
- continence
- eating and drinking
- shopping, cooking and cleaning

15

list some drugs that can cause confusion/affect memory when prescribed in older people

antipsychotics
benzodiazepines
antimuscarinics
opioid analgesics
some anticonvulsants

16

list some drugs that have a narrow therapeutic window when prescribed in older people

digoxin
lithium
warfarin
phenytoin
theophyllines

17

list some drugs with a long half-life when prescribed in older people

long-acting benzodiazepines (diazepam, nitrazepam)
fluoxetine
glibeclamid

18

list some drugs that can cause hypothermia when prescribed in older people

antipsychotics
TCAs

19

list some drugs that can cause Parkinsonism/movement disorders when prescribed in older people

metoclopramide
antipsychotics
stemetil

20

list some drugs that can cause bleeding when prescribed in older people

NSAIDs
warfarin

21

list some drugs that can predispose to falls when prescribed in older people

antipsychotics
sedatives
antihypertensives (esp. alpha blockers, nitrates, ACE inhibitors)
diuretics
antidepressants

22

what is polypharmacy?

when a patient is taking a large number of different prescription medications (some define this as 4+), often some which aren't needed.

23

list some potential reasons for polypharmacy in older people

- multiple chronic disease processes requiring specific drug treatments
- multiple physicians involved in care (for different diseases)
- admission to residential/nursing home
- failure to review medication and repeat prescriptions
- failure to discontinue unnecessary medication
- failure of dr to recognise poor therapeutic response as non-compliance
- prescribing cascade - more and more drugs added on in attempt to treat what are actually side effects of the original drugs

24

list possible causes of falls in the elderly

- drugs e.g. sedatives, alcohol
- MSK e.g. OA of hip
- syncope e.g. vasovagal, cardiogenic, arrhythmias
- stroke/TIA
- postural hypotension - secondary to antiHTNs, hypovolaemia, dopaminergic drugs
- neurological - peripheral neuropathy, Parkinson's
- hypoglycaemia
- visual impairment
- vertigo e.g. BPV, meiere's disease
- poor environment (e.g. dim light, loose rugs)
- dementia

25

what are the three main features of Parkinson's?

1) tremor
2) bradykinesia
3) rigidity - lead-pipe, cogwheel

26

list 3 differentiating features of a parkinsonian tremor

- slow, pill-rolling
- worse at rest
- asymmetrical
- reduced on distraction
- reduced on movement

27

what is the underlying pathophysiology of Parkinson's?

loss of dopaminergic neurons in substantia nigra

28

what class of drug is normally combined with L-dopa to prevent peripheral side effects?

dopa decarboxylase inhibitor e.g. carbidopa or benserazide

29

list some potential complications of L-dopa therapy

- 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)

30

how do immediately manage a TIA?

ABCDE assessment
aspirin 300mg daily started immediately (+PPI if needed)
specialist assessment within 24hrs of onset of symptoms - or within a week if the suspected TIA was more than a week ago