Elderly Medicine Flashcards
(36 cards)
What percent of elderly adults (over 65) have some decayed/ unsound teeth?
over 50%.
What are two challenges with elderly patients?
more CHRONIC DISEASES (cardiovascular, neurological, respiratory, diabetes, rheumatological) AND more COMPLICATIONS (more potential complications during treatment, more oral effects of diseases, more drugs).
What worsens the oral health issues of frail elderly patients (apart from disease and complications)?
access, income, “nothing can be done’
What is fraility?
Think of Ds: disability, dementia, delirium, depression, denourishment (aka malnutrition), destitution, dependency, drugs, death.
What is a common frailty scale used?
rockwood frailty score
How can patients lose their manual dexterity with age??
- Neurological disease (ex. parkinsons or stroke)
- rheumatological disease (ex. osteoarthritis or rheumatoid arthritis).
How do patients lose their physical capacity with age?
Respiratory disease
- COPD
Heart disease
Heart failure
Kidney failure
Anaemia
Cancer
Examle of how older patients lose their physiology with age?
loss of thirst reflex
Disability considerations in dentistry?
High risk of adverse events eg chest pain, shortness of breath
Manual dexterity
Access to services
Visual deficits
Communication issues
Allow for extra time & don’t rush them
Respect
What sensory disabilities do elederly people get with age?
- Visual (Age related macular degeneration, Cataracts).
- Deafness
- Impaired taste
What is multi-infarct dementia?
- made up of lots of blocked small blood vessels.
What is lewy body dementia linked with?
parkinson’s
What are 4 causes of dementia?
- alzheimers (60%)
- multi-infarct (20%)
- lewy body (15%)
- others (5%)
What is the pathological process of dementia?
Can somewhat tell from disease trajectory and symptoms but can’t fully tell until post-mortem.
What is dementia?
Global loss of brain function (cognition, function, personality)
How is dementia diagnosed?
Mainly CLINICAL (history taking, examination, rests of cognition, investigations).
How is dementia treated?
- Mainly non-pharmacological aka SUPPORTIVE.
- drugs can be used to DELAY, NOT cure (CHOLINISTERASE INHIBITORS).
- symptom control using SEDATIVES, yet these increase mortality
What would you be wary of prescribing to patients with dementia? Why?
Codeine, risk of delirium
What act to consult for a patient with dementia to assess ability to consent?
Adults with Incapacity Act 2000 Sect 47
What document may be needed for a dementia patient who lacks capacity?
Adults with incapacity form from GDP
What are some considerations with dementia patients?
- Neglect
- Comprehension
- Capacity to consent (Adults with Incapacity Act 2000 Sect 47)
Assess capacity for each intervention
Must be able to understand information, retain , balance information and communicate decision back
Maximise communication & comprehension
If lacks capacity needs AWI form from GP - Compliance
- Interaction with carers and relatives
- Be respectful
- Prescribing
Risk of delirium (acute confusion) with analgesics
What is delirium and how is it diagnosed?
ACUTE CONFUSIONAL STATE
- confusion assessment method
- screening tool (4AT)
What are predisposing factors to delirium?
- Frail body (age, multimorbidity, advanced illness, malnutrition)
- Frail mind (age, stroke, dementia, depression)
What are CAUSATIVE factors if delirum?
Often multiple underlying causes: Infections, New drugs/drug interactions, Pain, Dehydration, Unusual environment/ people
Often pre-existing dementia
