Geriatrics Flashcards
What is the difference between physiological and pathological ageing?
Physiological ageing is the normal physiological process of ageing after the 3rd decade of life (such as reduced GFR)
Pathological ageing is an abnormal ageing process due to the cumulation effect of co-morbid or age-associated conditions, that accelerate the risk of frality and functional decline.
Name some assessment tools of determine the medical, functional, and psychological capabilities of an elderly person.
Comprehensive Geriatric Assessment (CGA)
Timed-up-and-go test - test for fall risk
ADL/IADL - test for function
Geriatric depression score - test for mood
Abbreviated mental test - test for cognition
What are the factors in ADLs and IADLs?
ADLs (DEATHS)
D: Dressing E: Eating A: Ambulating T: Toileting H: Hygiene S: Swallowing
IADL (SHAFT)
S: Shopping H: Housekeeping A: Accounting F: Food preparation T: Transport, Take Meals, Telephone
Name 5 determinants of ageing
- Personal determinants
- Social determinants
- Behavioural determinants
- Physical environment
- Health and Social Services
What is rehabilitation?
Rehabilitation is the restoration of physical, mental, and social capacity of an individual through a structured, patient-centered multidisciplinary process.
Describe the components of goal setting in rehabilitation.
- Ascertain the problem and potential goals that are important to the patient and family
- Discuss with patient and family their concern and expectations, and explain the degree of restoration / goal towards outcome
- Detail what has to be done, how, where and when by the patient and the family
- Plan strategies to overcome anticipated barriers
- Discharge planning start early and evaluation action plan outcome
- Review goal as patient progresses, and praise successes.
List a few factors that affect successful rehabilitation
- Patient’s motivation
- Caregiver support / social support
- Expectations from patient
- Resilience to overcome barriers
- Time from onset
- Co-morbidities
- Nutritional status
- Motor function
Name a few consequences of immobility.
- CNS: deterioration of balance and coordination
- CVS: deep vein thrombosis
- Respi: pneumonia
- GIT: constipation
- Urogenital: Urinary incontinence, incomplete bladder emptying
- MSK: osteoporosis; increased risk of fracture; contracture; loss of muscle strength
What is functional decline?
Reduce ability to perform everyday tasks due to the decrement in physical and cognitive functioning
Name a few causes of functional decline.
all the Ms
- Medical co-morbidities
- Health deterioration (worsening of existing health conditions)
- Mind: stroke, intracranial haemorrhage, meningitis
- Medications: sedative / hypnotics; narcotics
- Metabolism: electrolyte dysfunction, hypoglycemia
- Acute kidney injury, dehydration
Describe the 4 health strategies that can be applied in the management of functional decline.
- Preventive: mitigate the risk factors that may result in further functional decline
- Curative: treat treatable disease and relieve symptoms (e.g. surgery, chemotherapy, organ transplant)
- Rehabilitation: restoration of function by improving, recover or decline in physical, mental, or social function
- Supportive: maintain functioning capacity and provide nutritional, mobility, emotional, and social support
Describe 6 strategies to prevent functional decline.
- Awareness of the risk and likelihood of functional decline
- Identify and manage risk factors associated with functional decline
- Implement preventing strategies or established protocols aimed at reducing the risk factors
- Conduct comprehensive geriatric assessment (i.e. physical, functional, cognitive, etc)
- Evaluate the appropriateness of medications
- minimise the use of sedative / hypnotics / narcotics medications
- ensure correct medication dosage & frequency
- monitor response to drug therapy - Manage and improve self-care: nutrition, mobility, cognition, emotions, mental, adequate hydration
List the drug classes that older adults are at an increased risk of toxicity.
Analgesics (e.g. NSAIDs, opiods)
Anticoagulant (e.g. warfarin)
Antihypertensive - increased risk of postural hypotension
Anticholinergics (e.g. tricyclic antidepressants; first generation antihistamines; antimuscularics like oxybutynin)
Benzodiazepines (e.g. diazepam)
Insulin & oral hypoglycemics agents
Factors that predispose older adults to adverse drug reactions
Polypharmacy - increase the risk for adverse drug-drug interactions
Age-related changes in pharmacokinetics and pharmacodynamics
- reduce hepatic & renal function -> prolonged elimination and clearance
- increased sensitivity to drugs
- Increased distribution of lipid soluble drugs due to increased adipose tissue
- increased level of unbound drug due to decreased plasma protein
Differentiate delirium, dementia, and depression in elderly.
See slides. Can’t attached picture.
