Geriatrics Flashcards
Define frailty
State of increased vulnerability resulting from ageing-associated decline in physiological reserve and function across multiple systems
Results in adverse outcomes following minor stressors
Give an example of linked comorbidities seen in geriatrics
Smoking and COPD and lung cancer
Give an example of unlinked comorbidities seen in geriatrics
Diabetes, dementia and myeloma
Name the geriatric giants (4 Is)
Instability, intellectual impairment, incontinence, immobility
Name the geriatric giants
5 Ms
Mind, mobility, medications, multi-complexity, matters most
What is deconditioning?
Geriatric patients bedbound for days/weeks. See confusion, poor nutritional state (even prior to admission) and made worse by acute illness.
Ie old people have a series of physiological changes after prolonged periods of being in bed
Describe the clinical frailty score
Score of 1-9 with 1=very fit 2=well 3=managing well 4=vulnerable 5=mildly frail 6=moderately frail 7=severely frail 8=very severely frail 9=terminally ill
What comes under best practice for orthogeriatrics?
Prompt surgery within 36 hours, prompt orthogeriatric assessment within 72 hours, pre-op cognitive testing, delirium assessment after op, prompt mobilisation after surgery, fracture prevention assessment, nutritional assessment
Ways of assessing frailty?
CFS, walking speed, grip strength
If someone has fallen from standing height and broken their hip what must you consider?
BONES! probably got osteoporosis so need to be thinking about bisphosphonates, calcium and vitamin d replacement
Options for bisphosphonates
Oral alendronic acid/alendronate
IV zoledronic acid
Pros and cons of oral bisphosphonates
Pros: don’t need to be stabbed, can leave the patient to it
Cons: need to take it on a completely empty stomach, 30mins-2 hour before food or other fluids, take with a large gulp of water, need to remain sat upright for at 30 mins after taking it, can’t take with other medication
Pros and cons of IV zol
Pros: one injection lasts a whole year
Cons: a needle, have to give it over 15 mins, need to come in to have it
Name the rapid test for delirium
4AT : alertness, AMT4, attention, acute change/fluctuating course
Define delirium
acute confusional state that fluctuates in severity and is usually reversible
Usually the result of other organic processes
Define dementia
syndrome of acquired chronic global impairment of higher brain function, in an alert patient, which interferes with ability to cope with daily living
What are BPSDs?
Behavioural and psychological symptoms of dementia
Non cognitive symptoms eg agitation, depression, irritability, disinhibition, hallucinations
What do you see in hyperactive delirium?
Agitation, delusions, hallucinations, wandering, aggression
What are potential causes of delirium?
PINCH ME
Pain, infection, nutrition, constipation, hydration, medication, environment
In what proportion of patients is delirium preventable
1 in 3
What do you see in hypoactive delirium?
Can be confused with depression: lethargy, slowness, excessive sleeping, inattention
Give some examples of reversible dementias?
Around 10%
Depression, B12/folate, hypothyroid, normal pressure hydrocephalus
Describe the FRIED criteria
Frailty=clinical syndrome if at least 3 of:
Unintentional weight loss, self-reported exhaustion, weakness, slow walking speed, low physical activity
2 criteria=pre-frail
What are causes of malnutrition?
Decreased nutrient intake (starvation), increased nutrient requirements (sepsis, injury), inability to utilise nutrients ingested (malabsorption), combination of different reasons
