Geriatrics Flashcards
(34 cards)
What are the 5 Geriatric Giants? (all begin with I)
- Immobility
- Instability
- Intellectual Impairment
- Incontinence
- Inability to manage ADLs
Name some reversible causes of incontinence (5+) mneumonic:
DIAPPERS
- Delirium
- Infection
- Atrophic Vaginitis
- Pharmaceutical
- Psychological
- Excess Fluids
- Restricted Mobility
- Stool (constipation)
Suggest 4 aspects of care that should be considered in a Comprehensive Geriatric Assessment (CGA)?
- medical: e.g. co-morbid, med review, nutrition..
- mental health: cognition, mood, anxiety/fears
- functional capacity: ADLs, gait/balance, PS
- social circumstances: informal carers, social network
- environment: home safety, facilities, technology
What does OPAL stand for? What is their job?
- older person’s assessment and liason team
- evaluate CGA in acute medical inpatients
What should you ask about in a falls history? (6+)
- do they know why they’re in hospital
- any pain? bump to head?
- loss of consciousness?
- did you trip? medications?
- how did you feel before fall? Dizziness? palpitations? light headedness?
- time on floor?
- history of falls
- mobility, home environment
Donepazil is a medication used to treat what? What effect can it have on HR?
Alzeihmers/Dementia
-slows HR by ~3bpm so can worsen bradycardia
What is a side effect of amlodipine for which some pts are on small doses of furosemide unecessarily?
swollen feet
Why is LUTZ e.g. from vaginal prolapse in an elderly person a RF for falls?
- urge/stress incontinence
- rushing to toilet esp. with poor mobility
- incontinence could lead to slipping on urine
What is onychogryphosis?
-hypertrophy of the nail bed (v. long toenails)
What describe a brain age-related change that increases the risk of falls:
-brain atrophy, loss of neurones, reduced synaptic transmission so slower processing speed and loss of proprioceptive sensitivity and impaired vestibular system
What describe a MSK age-related change that increases the risk of falls:
- sarcopenia (loss of skeletal muscle mass) >in legs than arms
- lumbar lordosis, thoracic kyphosis, cervical lordosis postural changes
- reduced stride length and gait speed and a wide based gait
What is presbycussis?
Age related bilateral sensory hearing loss
Name 5 age-related changes in the eyes that increases the risk of falls:
- deterioration in static acuity
- loss of dynamic visual acuity
- pupil becomes rigid and less elastic
- lens becomes opaque
- slow reaction to changes in lighting
- reduced sensitivity to colour contrast
- long-sightedness
- co-morbidities: cataracts, ARMD. glaucoma, retinopathy, stroke
Name 4 CVS pathologies/co-morbidities that increase the risk of falls:
- orthostatic hypotension
- post-prandial hypotension
- carotid sinus syncope
- neurocardiogenic syncope
- arrhythmias
- valvular heart disease
Name 4 balance/gait co-morbidities that increase risk of falls:
- Stroke
- Parkinsonism
- Arthritis
- Neuropathy
- Vestibular disease
- Neuromuscular Disorders
Name 2 alpha blockers, why are they problematic in elderly and falls?
- doxazocin
- tamsulosin
- postural hypotension
Investigations for a pt whose had a fall:
- culture urine
- ECG - make sure named and dated
- postural lying/standing BP
- X-ray e.g. baseline CXR
- routine bloods
- U&Es
- LFTs
Name 3 secondary complications following a fall:
- chest infections/HAIs
- pressure sores
- dehydration
- muscle atrophy
- burns
- hypothermia
Suggest 5 things that will come under a multifactorial risk assessment after a pt has had a fall:
- cognitive impairment, sensory impairment screen
- syncope risk
- visual assessment
- footwear assessment
- co-morbidity management
- medication review
- balance/mobility problems
- home hazards (OT)
- falls history
- continence problems
Dementia definition:
A loss of ___ ___ severe enough to ____ with normal ___, lasting >___, not present since birth and not associated with ___/____ of ____
- loss of mental ability
- interfere with normal ADLs
- lasting >6months
- not associated with Loss/Alteration of conciousness
Mild cognitive impairment causes cognitive changes that are serious enough to be noticed by the individuals experiencing them/to other people but the changes are __ ___ ___ to ___ with __
-not severe enough to interfere with daily life/independent function
NB: these pts have insight
Mocha test is used for testing for
-dementia
Lewy body dementia has a rapid decline, what problems are seen?
NB: if cognitive impairment started before parkinsons = lewy body
-if parkinsons >1yr then cognition falls = parkinson’s dementia
- visuospatial problems
- behavioural issues
- hallucinations/delusions
A very rapid declining dementia with myoclonic jerks is likely to be the rare type of dementia related to ___
CJD
