Comprehensive Geriatric Assessment Flashcards
(103 cards)
1
Q
What is comprehensive geriatric assessment?
A
determining the medical, psychological and functional capabilities of an older person as well as their social and environmental needs
2
Q
What is sarcopenia?
A
age related loss of muscle mass and function
3
Q
What is a proven intervention for sarcopenia?
A
progressive resistance training
4
Q
How often should strength and balance work be carried out?
A
at least 2x a week
5
Q
What else can be useful in tackling sarcopenia?
A
nutrition- calcium and vitD, protein supplements; creatinine; ACEi
6
Q
What is often a trigger for immobility and sarcopenia?
A
intercurrent illness
7
Q
What is reablement?
A
regaining skills, confidence and independence
8
Q
What is habilitation?
A
assisting an individual with achieving skills when impairments have caused delays or blocks
9
Q
What are some of the consequences of sarcopenia?
A
insulin resistance and diabetes; falls and fractures and dependence on others
10
Q
What is a starting dose of oramorph?
A
2.5mg qds
11
Q
What should be prescribed in addition to morphine?
A
a laxative and antiemetic
12
Q
What is a breakthrough dose of oramorph?
A
2.5mg or 1/6 of total daily dose
13
Q
What should be used as background analgesia?
A
long-acting MST
14
Q
What is the best option for delivery of medicine in palliative care?
A
continuous subcut infusion using a syringe driver
15
Q
How many medicines can be mixed together in a syringe driver?
A
up to 3
16
Q
What is the difference between dosing morphine from PO to SC?
A
morphine is x2 as potent given SC
17
Q
What should be given for pain or SOB?
A
morphine
18
Q
What should be given for distress?
A
midazolam
19
Q
What should be given for nausea/agitation?
A
levomepormazine
20
Q
What should be given for respiratory secretions?
A
buscopan
21
Q
What is a stroke?
A
rapidly developing symptoms of loss of brain function of vascular origin lasting longer then 24 hours
22
Q
What are the 3 types of stroke?
A
haemorrhage; subarachnoid haemorrhage and infarct
23
Q
What is the main treatment for stroke?
A
thrombolysis
24
Q
What is an example of a thrombolytic agent used in treating stroke?
A
alteplase
25
When should patients with stroke be thrombolysed?
within 3 hours
26
What factors should be taken into consideration when deciding whether to thrombolyse?
age; time since onset; previous haemorrhage or infarct; atrophic changes; BP; DM
27
What was previously the only proven treatment for acute ischaemic stroke?
IV tPA
28
What is the time limit on using tPA?
less than 4.5hours from symptom onset
29
What is the option for patients who are unsuitable for tPA or do not respond well?
endovascular therapy
30
What is the initial mx for a stroke?
thromolysis/thrombectomy; imaging; swallow; nutrition and hydration; antiplatelets; DVT prevention
31
What is used for DVT prevention?
intermittent pneumatic compression
32
why is LMWH not used for DVT prevetion?
risk of bleeding is too high
33
Why are TED stockings not used?
trials have shown they dont give an overall benefit
34
What are the 3 types of haemorrhagic stroke (not including subarachnoid)?
structural abnormality; hypertensive and amyloid angiopathy
35
What are the 3 main types of infarct stroke?
atheroembolic; small vessel and cardioembolic
36
What type of thrombus is found in cardioembolic?
fibrin dependent- "red thrombus"
37
What type of thrombuc is found in atheroembolic stroke?
platelet dependent- "white thrombus"
38
What are the causes of small vessel stroke
arteriosclerosis; microatheroma of the ostium; embolism etc.
39
What Ix can be used to look at the aetiology of the stroke?
carotid scan; angiogram; ECG; echo; bubble TCD or echo
40
What is first line antiplatelet if not cardioembolic?
clopidogrel
41
What scoring system can be used to quantidy stroke risk in AF?
CHA2DS2VASc
42
What do these stand for?
```
CHF/LV dysfunction
HT
age >75
DM
Stroke/TIA/thrombo-embolism
vascular disease
age 65-74
sex category
```
43
What is the bleeding risk with warfarin compared to aspirin?
similar
44
What scoring system can be use to quantify bleeding risk?
```
HAS-BLED
HT
abnormal renal/liver fx
stroke
bleeding
labile INRs
elderly
drugs/alcohol
```
45
What drug shouldnt be used with cardioembolic stroke?
aspirin
46
What are the features of delirium?
disturbance in attention; change in cognition; develops over a short period and fluctuates and has a cause
47
What are the two forms of delirium?
hypoactive and hyperactive
48
Which form of delirium is associated with worse outcomes?
hypoactive
49
What causes delirium?
not sure-- varaible derangement of neurotransmitters-ACh; direct toxic insults to brain; aberrant stress responses
50
What are the predisposing factors for delirium?
old age; dementia; co-morbidity; post-op period; terminal illness; sensory impairment; polypharmacy; depression; alcohol dependency; malnutrition
51
What are precipitating factors for delirium?
drugs; hypoxia; glucose; constipation; alcohol; infection; unfamiliar environment; catheter; pain; feer; heart attafck; fractures; dehydration
52
what are the hallmarks of delirium?
acute and fluctuating; inattention; altered level of consciousness; disorganised thinking
53
What is hyperactive delirium?
agitated, aggressive, wandering
54
What is hypoactive delririum?
withdrawn, apathetic, sleepy and coma
55
What tools can be used to diagnose delirium?
CAM and 4AT
56
What is the mx of delirium?
identify and reverse all underling causes; check hydration; strop nephrotoxic drugs; optimise BP and perfusion, look for intrinsic renal disease
57
When should sedation be used?
only if pt is danger to themselves or others
58
What should be done if sedation is used with a patient?
document clearly the reason
59
What drug should be used for sedating generall?
haloperidol 2.5mg
60
What sedative should be used for patients with PD or lewy body dementia?
quetiapine
61
What sedative should be used for patients with alcohol or benzo withdrawal or seizures?
lorazepam- but can worsen delirium
62
Why should delirium patients be followed up?
delirium is a risk factor for dementia and further episodes; delirium can be distressing
63
What are the consequences of immobilisation after a fall?
hypothermia; dehydration; presssure sores; rhabdomyolysis; VTE; pneumonia; muscle deconditioning
64
What happens to the eyes during ageing?
smaller pupils and thickened lenses decreasing light
65
What are the common causes of syncope?
arrythmia; orthostatic hypotension; vasovagal; carotid sinus hypersensitivity; valvular heart disease
66
What is orthostatic hypotension defined as?
fall in SBP >20mmHg or fall in DBP >10mg
67
What are the key neurological disorders implicated in falls?
cervical myelopathy; lumbar stenosis; peripheral neuropathy; parkinsons; stroke; cerebellar ataxia
68
What is the diagnostic test for BPPV?
dix-hallpike manoeuvre
69
What are extrinsic risk factors for falling?
medication; alcohol; environmental hazards; inappropriate clothing/footwear and walking aids
70
What are common drugs that increase falls risk?
benzos neuroleptics; anti-HTs; antidepressants; anticholinergics; class 1A antiarrthymics
71
What 3 questions should be asked routinely to screen for pts who are falls risks?
have you had 2 or more falls in the last 12 months; have you presented acutely with a fall; do you have probelms with walking or balance
72
What should be done as part of the assessment after a fall?
gait; balance; joints; neurological; CVS; visual acuity; feet and footwear; incontinence assessment
73
How should lying and standing BP be carried out?
1- after lying for at least 5 mins
2- after standing in the 1st minute
3- after standing for 3 minutes
74
What intervention for falls has the strongest evidence?
strangth and balance training
75
What causes human aging?
random molecular damage during cell replication
76
What factors increase molecular damage during cell replication and therefore increase ageing?
inactivity, poor diet, inflammation
77
What is the process that leads to cell senescence?
telomeres foudn at the end of chromosome arms shorten with each cell replication, when becomes too short to sustain replication--senescence
78
What causes damage to macromolecules?
ionising radiation; reactive oxygen species; extrinsic toxins
79
What are the 4 main cellular responses to damage?
repair; apoptosis; senescence and malignant transformation
80
What is the disposable soma hypothesis?
to fully repair a body would take lots of energy and resources and once past reproductive age, no point
81
what is the antagonistic pleiotropy theory of ageing?
genes may be beneficial early in life but harmful later on
82
What is frailty?
loss of homeostasis and resilience
83
What are the consequences of frailty?
increased vulnerability to decompensation after a stressor; increased falls, delirium, disability and death
84
What are the 2 score systems used for measuring frailty?
Rockwood score (deficit accumulation) and Fried score ( phenotypic)
85
What is physical activity in old age protective against?
heart disease; DM; some cancers; mild depression; dementia and alzhemiers
86
Give examples of acetylcholinerterase inhibitors?
donepezil; galantamine; rivastigmine
87
What is the action of memantine?
low-affinity non-competitive antagonist of NMDA receptors
88
What is memantine licensed for?
Alzheimers
89
What type of memory does Alzhemiers affect first?
short-term
90
What area of the brain is affected initially in alzhemiers?
hippocampus
91
What is the definition of dementia?
progressive, irreversible cognitive decline in at least 2 areas of cognition
92
What is average death after diagnosis of Alzhemiers?
7-10 years
93
What are neurofibrillary tangles?
Tau protein (microbtubules) become hyperphosphorylated
94
What type of matter is affected first in vascular dementia?
white >grey
95
What are the early signs of vascular dementia?
early dysphagia and dyscalculia
96
What proteins are implicated in Lewy Body Dementia?
ubiquitin and a-synuclein
97
What are the features of Lew Body dementia?
fluctuating confusion; visual hallucinations; autonomic instability-hypotension; REM sleep behavoiur disorders
98
What ar ethe features of fronto-temporal dementia?
behavioural changes; progressive non-fluent aphasia; semantic dementia; disinhibition
99
What is the triad of symptoms seen with thiamine deficiency?
ophthalmoplegia; confusion; ataxia
100
What are the signs of wernickes?
visual impairment; hearing impairment; reduced conscious level; hypothermia; lactic acidosis; circulatory changes
101
What happens in korsakoffs syndrome?
Antegrade amnesia; telescoping of events; confabulation
102
What area of the brain is affected in korsakoffs?
Atrophy of mammillary bodies
103
What age do patients tend to get fronto-temporal dementia?
60-65
