Clinical Seminar: Older Persons' Health and Digital Rectal Examinations Flashcards
(17 cards)
What are some physiological considerations that need to be considered when taking a hx from an elderly patient?
- May not respond as dramatically to infection (fever, WCC etc)
- May not be as haemodynamically robust
- May not have same electrolyte stability (risk that come with polypharmacy etc)
Environmental considerations when taking a history from an older patient
- Is there enough time?
- Is the environment too loud?
- Can they hear/see us?
History and exam considerations in older patients
- Consider closed questions if patient rambles/can’t remember long sentences/trains of thought
- Set up exam room to be accessible so that the patient can have the full exam even in spite of mobility limitations
Investigation considerations in older patients
- Mobility/financial constraints may make getting investigations harder than otherwise
- Discuss necessity of these interventions with the patient; do they really need all these things?
Considerations of disease management in older patients?
- Can they cope with the logistics of medications?
- Are they likely to have drug reactions?
- Will management impact their driving/ADLs?
- Consider handouts etc
Safety considerations in older patients
- Driving each year over 75
- Socially; are they doing well at home? Do they have an advanced care directive?
List some common geriatric syndromes
- Falls
- Frailty
- Incontinence
- Delirium
- Cognitive decline/dementia
- Polypharmacy
- MDD/GAD
What do we need to consider when assessing/managing an older person who’s had a fall?
- Think: why did they fall (broad surgical sieve). As a consequence of fall, are there nay new problems.
- Then, fall back to BLS, check for any acute MI/neuro/bleeding issues, and stabilise C spine with arms
- Then, review what other causes could be (once confirmed that there’s no emergency).
- Head to toe physical exam
What is the medical definition of frailty?
Increased susceptibility to adverse health outcomes
Risk factors for frailty in elderly people
- Less physical activity
- Polypharmacy
- Being single
- Other comorbidities (e.g. heart disease, osteoporosis, clotting issues, lung disease)
- Smoking
Clinical features/tests that could indicate frailty
- Unintenional weight loss >4kg/1yr
- Exhaustion
- Slow gait speed
- Low physical activity
- Slow “up and go” test (move 3m from chair + back)
Clinical consequences of frailty
- Poorer MSK robustness
- Poorer immune response to infection/vaccine
- Undernutrition/poor energy response to food
Outline cognitive tests that can be used when assessing patients (such as elderly patient)
- Frontal assessment battery (discriminate between frontal dysexecutive dementia and alzheimer’s)
- MMSE (mental status)
- MOCA (good for mild cognitive decline)
- RUDAS (miniminse; RUDEness of cultural differences)
- KICA (Kimberley; for older indigenous Australians)
Algorithm for assessing cognitive impairment in a patient
- Are they safe? (licenses [car/gun], household [?abuse, financial safety, is their home safe?])
- Gauge cognitive function (what tests can be used?)
- Any reversible causes? (depression, deficiencies, medication based, anaemia)
Indications for DRE
- Incontinence
- Constipation
- Trauma/SCI
- Acute gastrointestinal bleeding
Relative and absolute contraindications for DRE
- Relative: sharp foreign body (could be pushed in/hurt)
- Absolute: imperforate anus
What are the stages of a digital rectal exam?
- Look (skin tags, excoriation [?itchiness from dermatitis, haemorrhoids], fissure [?constipation], fistula (?IBD), bleeding, warts
- Get them to cough (check for prolapse, internal haemorrhoids)
- Lubricate/warn/insert finger; turn 360 degrees to check for abnormality. In men, check size/shape/symmetry of prostate.
- Get them to bear down on your finger
- Upon removing finger, check for fresh/digested blood, or mucous
