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Elderly Care Flashcards

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1
Q

name a few reasons why people are getting older

A
  • better resources and care
  • better financial stability
  • screening programmes picking up disease sooner
  • diseases have better outcomes
  • better provisions for chronic diseases
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2
Q

name the three theories involved in ageing, and give a brief description of each

A
  • stochastic: accumulation of random changes that cause damage and ageing
  • programmed: specific sets of cells are programmed to stop working at a certain point in life
  • homeostatic failure: ageing caused by body’s loss of ability to maintain homeostasis
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3
Q

why are age and frailty not synonymous?

A

because ageing has lots of variability, an elderly person isn’t necessarily frail

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4
Q

why does eGFR in elderly people stay the same?

A

because even though creatinine clearance goes down, there is also less muscle mass so overall the eGFR remains unchanged

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5
Q

what are the main effects on the kidneys, heart and lungs as people age?

A

kidneys - reduced creatinine clearance
heart - increased blood pressure, reduced cardiac output
lungs - reduced vital capacity

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6
Q

what is the definition of frailty?

A

the body’s increasing inability to maintain homeostasis

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7
Q

what are the four “frailty syndromes”?

A
  • incontinence
  • confusion/delirium
  • falls
  • immobility
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8
Q

what is a consequence of reduced carotid baroreflex sensitivity in elderly patients?

A

inaccurate regulation of blood pressure

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9
Q

what is meant by social dyshomeostasis in elderly people?

A

inability to cope with changes in social circumstances or environmental inputs

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10
Q

define redundancy in the context of elderly medicine and frailty

A

redundancy is the ability to overcome a crisis, therefore elderly people tend to have lower redundancy

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11
Q

what are the 5 signs that make up the frailty phenotype?

A
  • unintentional weight loss
  • weak grip strength
  • exhaustion
  • low physical ability
  • slow walk
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12
Q

name all the possible health domains

A
  • psychological
  • physical
  • environmental
  • social
  • spiritual
  • medical
  • cognitive
  • financial
  • functional
  • behavioral
  • nutritional
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13
Q

how is frailty related to health domains?

A

frailty can be caused by a disruption of any of a patient’s health domains; disruption in one health domain can precipitate disruption in other health domains

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14
Q

what is the Comprehensive Geriatric Assessment?

A

it’s a process carried out to assess and manage illness in older people with frailty

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15
Q

who carries out the comprehensive geriatric assessment, and what are the main two aims?

A

carried out by MDT
main aims are:
- recognise medical problems
- recognise which health domains are affected
- decide which aspects can be reversed or improved

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16
Q

in terms of risk and benefit, what considerations should be made for elderly patients with regards to hospital admission? explain why

A
  • hospital admission is beneficial early on: it allows for accurate tests and resources
  • hospital admission becomes increasingly risky with time: infection, iatrogenic harm, confusion, muscle wasting
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17
Q

name a few extrinsic factors which may contribute to incontinence in elderly people

A
  • habits
  • drugs
  • social circumstances
  • environment
  • cognitive state
  • fluid intake
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18
Q

what are the main four intrinsic factors that contribute to incontinence?

A
  • bladder too weak
  • bladder too strong
  • outlet too weak
  • outlet too strong
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19
Q

what are the there main types of incontinence?

A
  • stress incontinence
  • urge incontinence
  • retention incontinence
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20
Q

what does an overactive bladder lead to?

A

urge incontinence

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21
Q

what does a weak bladder outlet lead to?

A

stress incontinence

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22
Q

what does a strictured bladder outlet lead to?

A

retention incontinence

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23
Q

what is the mainstay non-pharmacological treatment for stress incontinence?

A

pelvic floor (Kegel) exercises

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24
Q

what is the mainstay pharmacological treatment for urge incontinence? what is a downside of it?

A

anti-muscarinics; they have lots of side effects as they affect muscarinics receptors all over the body

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25
what is the mainstay pharmacological treatment for retention incontinence? give examples
``` alpha blockers (eg tamsulosin) anti-aldosterone drugs (eg finasteride) ```
26
give an example of anti-muscarinic drugs used to treat urge incontinence
oxybutinin, solifenacin
27
name some of the side effects that come with anti-muscarinics used for urge incontinence
dry mouth blurred vision constipation bradycardia
28
name a possible cause of retention incontinence in males and females
males - BPH | females - fibrosis
29
what is mirabegron and what is it used for?
adrenoceptor agonist | relaxes detrusor muscle, used for urge incontinence
30
what are the four main types of drugs used to treat incontinence?
- alpha-blockers (eg tamsulosin) - beta3 adrenoceptor-agonists (eg mirabegron) - anti-muscarinics (eg oxybutinin, solifenacin) - anti-aldosterone drugs (eg finasteride)
31
Name a few steps to take in the investigation and management of urinary incontinence
- Detailed history (esp drugs, extrinsic factors) - Examination (also PV and PR) - Residual bladder scan - MSSU and urinalysis - advice on lifestyle choices - Kegel exercises etc - referral if complicated cases
32
name a few types of incontinence containment measures used to maintain an incontinent patient's dignity
- incontinence pads - urosheaths - catheterisation (intermittent, suprapubic)
33
name some conditions which would require a patient with incontinence to be referred to specialists
- vesico-vaginal fistula - palpable bladder after micturition - neurological disease - failure of initial incontinence treatment - patients with BPH or prostatic carcinoma - patients with Hx of continence surgery
34
Name a few possible precipitants of delirium
- pain - electrolyte imbalance - drugs - alcohol/drug withdrawal - hypoxia - lack of sleep - change in environment - constipation - urine retention - infection - dehydration - brain injury
35
What percentage of hospital patients experience delirium during admission?
Up to 30% of admitted patients
36
Name a few non-pharmacological ways to deal with delirium
- calming the patient - restoring sleep pattern - reduce transfers and changes in environment - mobilise early
37
What investigation is unsuitable for elderly patients with confusion, and why?
Urine dipstick - elderly patients often have asymptomatic bacteriuria, not necessarily have a UTI. Dipstick would be misleading
38
Name some features of delirium
- confusion - altered consciousness (hyper or hypo) - sensory changes (hallucinations) - cognitive changes (language, memory) - disturbed sleep pattern - altered physical function
39
What is the screening tool called used to measure delirium?
4AT
40
What 4 sections are included in the 4AT delirium screening tool?
- alertness - AMT4 - attention - acute/fluctuating onset
41
List the steps you would take if a patient develops delirium
- history - examination - calm patient - treat underlying cause/precipitant - try to avoid medications to stop the delirium
42
When should medicines be considered to treat delirium?
If the patient becomes a danger to themselves or others by being in a delirium
43
name a few symptoms of adverse drug reactions which in elderly people can mimic the symptoms of growing old
- dizziness - delirium - incontinence - falls - depression - insomnia - fatigue - confusion - constipation
44
why might using guidelines for specific conditions not be the best way to manage those conditions in elderly patients?
because guidelines only take into consideration that one disease, and don't take into account the co-morbidities and polypharmacy normally found in elderly patients
45
name a few of the biggest culprits for ADRs in elderly patients
- NSAIDs - warfarin - diuretics - ACE inhibitors - beta-blockers - antidepressants - digoxin - opiates - prednisolone
46
which two types of drugs are known to be the biggest causes of ADRs in elderly patients?
anticholinergics | sedatives
47
with regards to pharmacokinetics, how is drug absorption affected by old age?
absorption rate slows down, but absorption extent remains the same
48
with regards to pharmacokinetics, how do physiological changes in old age affect drug distribution?
reduced water content - reduced distribution of water soluble drugs --> higher serum concentration increased fat content - increased distribution and storage of fat soluble drugs --> drug stays in system longer reduced albumin --> more free drug, higher serum levels of active drug BBB more permeable --> easier for drugs to cross into brain
49
with regards to geriatric pharmacology, why should elderly patients get a smaller loading dose of a drug that distributes well in muscle (eg digoxin)?
because elderly patients have lower muscle mass, therefore the loading dose of drug should reflect that
50
what happens to water soluble drugs in elderly patients, as a result of reduced body water content?
drug stays in circulation as it doesn't distribute as well, leading to high serum concentration
51
what happens to fat soluble drug in elderly patients, as a result of increased total body fat?
drug is distributed more widely and is stored in adipose tissue, increasing its half-life and taking longer to be metabolised
52
with regards to elderly pharmacology, how does a reduction in albumin production affect drug distribution in elderly patients?
reduced albumin leads to reduced protein binding in the blood, so there is a higher volume of unbound drug in circulation resulting in higher serum concentration
53
what are the four significant physiological changes in elderly patients which affect drug distribution?
- reduced body water content - increased body fat content - decreased albumin production - increased BBB permeability
54
with regards to pharmacokinetics, how does elderly age affect metabolism?
in old age drug metabolism is reduced, due to reduced liver mass and reduced liver blood flow
55
with regards to pharmacokinetics, how does old age affect excretion?
in old age drug excretion is reduced, due to reduction in kidney function and reduced creatinine clearance
56
which guidelines can be used for advice on geriatric drug prescriptions?
- BNF - Beer's criteria - START-STOPP criteria - Polypharmacy Guidance document
57
name a few psychiatric drugs which may be problematic in elderly patients, and why
sedatives (eg benzo's) - can cause confusion, falls anti-psychotics - postural hypo, stroke, confusion, mobility problems anti-depressants - less effective in elderly people
58
name a few analgesic drugs which may be problematic in elderly patients, and why
opiates - elderly patients more sensitive to effects, but some are not as effective (eg tramadol) NSAIDs - higher risk of bleeding, renal impairment
59
name a few cardiology drugs which may be problematic in elderly patients, and why
diuretics - incontinence and mobility problems, not as effective, excreted slowly digoxin - lower doses needed, toxicity risk anti-hypertensives - postural hypotension, BP and HR affected differently, higher risk of falls, renal impairment warfarin - risk of bleeding, renal impairment
60
name a few antibiotics which may be problematic in elderly patients, and why
aminoglycosides - renal impairment quinolones - delirium co-trimoxasole and trimethoprim - blood abnormalities all antibiotics carry risk of diarrhoea, c. diff infections and seizures in elderly patients
61
in terms of falls, in which settings are elderly patients who fell more likely to be very unwell?
in hospital settings
62
what are the two first things to find out if an elderly patient falls on a ward?
check for serious injury | investigate cause of fall
63
what important consequences of falls in a ward should not be missed?
``` subdural hematoma head injury fractured hip or limb abdominal injury spinal injury seizure ```
64
after an elderly inpatient fall, when should you CT immediately?
if GCS is low if still confused a few hours later if vomiting if seizures if skull fracture if basal skull fracture signs
65
after an elderly inpatient fall, when should you x-ray?
if pain on moving joint | if there is pain on weightbearing

Medical Specialties (4 decks)

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