Geriatrics Flashcards
(31 cards)
Cardiovascular in normal ageing
Less able to increase HR
BP goes up due to arterial stiffness
Increased LV wall thickening
Resp in normal ageing
Reduce VC
Loss of alveoli
Kidneys in normal ageing
Reduced GFR and impaired salt and water balance (unable to concentrate urine if need be)
Liver in normal ageing
Reduced blood flow and hepatic function
Skin in normal ageing
Reduced tugor
Immunity in normal ageing
Impaired immune response
Chronic activation of innate immunity
Ageing is associated with A) Mitochondrial oxidative phosphorylation B) oxidative stress C) protein synthesis D) telomere length E) RNA synthesis
Oxidative stress
How is ADME affected in elderly?
How does that affect loading and maintenance dose?
Absorption - slower, reduced 1st pass metabolism
D - affected by decreased muscle mass and increased fat
M - reduced hepatic blood flow volume, decreased phase 1, decreased phase II
Excretion - decreased CrCL
Loading dose - reduced for water soluble dose
Maintenance dose - reduced due to reduced clearance
How is pharmacodynamics affected in elderly?
Change in receptors and ‘sensitivity’
B-adrenergic system less sensitive e.g. beta blockers
CNS drugs - most sensitive e.g. opioids, BZD
The maintenance dose of digoxin is lower in an old person. Why?
Decreased renal clearance
Do OT home modifications reduce falls in all old people?
No
Only those who have been in hospital
Which of the following is most effective in reducing the risk of falling in community dwelling older persons?
A) Exercise program 2) Multifactorial interventions C) Vitamin D D) Interventions to improve home safety E) Reduce medications that increase the risk of falls
Exercise programs
E.g. taichi, balance programs
NEJM trial 2020 - multifactorial interventions administered by nurses did not result in rate of fall-associated injuries
Which of the following is most effective in reducing the risk of falling in hospitalised older persons?
A) exercise programs
B) multifactorial interventions
C) vitamin D
D) reduce medications that increase the risk of falling
E) medication review
Multifactorial interventions
Supervision is probably the strongest factor
Vitamin D is effective in reducing the rate of falls in RACF
Exercise in subacute hospital settings appears effective but its effectiveness in RACF remains uncertain
Which class of medications is most consistently associated with falls? A) BZD B) Beta blockers C) CCB D) Opioids E) statins
BZD
In order from most to least
Psychotropic Neuroleptic BZD Antidepressants TCAs Cardiac medications Opioids
What is the best way to differentiate dementia and delirium? A) language assessment B) STM recall C) visuospatial tests D) attention and calculation E) orientation
attention and calculation
What is the most likely precipitating factor for delirium in older people?
A) Change in environment B) change in meds C) infection D) stroke E) trauma
Infection
70M STML for 2 years Independent ADLs MMSE 27/30 (0/3 recall) Brain imaging periventricular white matter change A) AD B) FTD C) MCI D) DBL
MCI
What’s MCI?
Maintenance of function is the defining feature
Which of the following is the best predictor of conversion of mild cognitive impairment to dementia?
A) PiB PET
B) CSF beta amyloid levels
C) Structural MRI findings
D) Standardised tests of memory
E) Standardised tests of executive function
Standardised tests of memory
Which of the following tx reduce the rate of progression of mild MCI to AD? A) Ach inhibitor B) Cognitive rehab C) Exercise D) None of the above
None of the above
Neurofibrillary tangles are seen in what type of dementia?
AD
Ach inhibitors in mild to moderate dementia result in
A) Improvement in ADLs
B) Improvement in neurocognitive function
C) Longer time before entering RACF
D) Improved QOL
E) disease modifying activity
Improvement in neurocognitive function
Benefit is minor
68F Alert, orientated, appropriate Speech is fluent Word finding difficulties Cannot name animals when shown their picture Good recall A) amyloid plaques and neurofibrillary tangles B) tau neuronal inclusions C) TDP-43 neuronal inclusions D) lewy body E) Huntington neuronal inclusions
FTD
- Primary progressive aphasia (semantic) Subtype - associated with TDP-43
- Fluent speech but difficulty naming objects
Subtypes of FTD
Usually younger age (50s or 60s)
1) Behavioural variant (most common)
2) Primary progressive aphasia - semantic
3) Primary progressive aphasia - nonfluent
D) Logopaenic variant (AD aetiology)
