Geriatrics

Question 1

what are the various theories of ageing

Answer 1

stochastic- accumulate damage randomly and over time this degrades our system
Programmed- we are predetermined to die- certain points in life our gene expressions change
Homeostatic failure

Question 2

what are some physiological things that occur throughout ageing

Answer 2

reduction in muscle bulk
poorer kidney clearance
systolic BP increases and diastolic drops
CO decreases

Question 3

what are the frailty syndromes

Answer 3

falls, delirium, immobility, incontinence

Question 4

what is social dyshomeostasis

Answer 4

we rely on social constructs to survive and when you get older these too can degrade

Question 5

what is the definition of frailty

Answer 5

if you have 3 of the 5 
unintentional weight loss
exhaustion 
weak grip strength 
slow walking speed 
low physical activity

Question 6

what scale do we use to measure frailty

Answer 6

the clinical frailty scale

Question 7

what are the aims of geriatric assessment

Answer 7

goal centred
holistic
multidisciplinary

Question 8

what are the 2 peaks where we see incontinence

Answer 8

after menopause and in the elderly

Question 9

parasympathetic innervation to the bladder

Answer 9

S2-4 - increases strength and frequency of contractions

Question 10

Sympathetic innervation to the bladder

Answer 10

T10-L2- relaxes detruser

T10-S2- causes contraction of neck of bladder and the internal urethral sphincte

Question 11

somatic innervation to the bladder

Answer 11

S2-S4 contra action of the pelvic floor and the EUS

Question 12

what is stress incontinence

Answer 12

its when the bladder outlet is too weak

Question 13

what are the classical features of stress incontinence

Answer 13

urine leak on movement, coughing, laughing
weak pelvic floor muscles
often in women after children

Question 14

treatments for stress incontinence

Answer 14

physio, oestrogen cream, duloxetine, surgery (TVT/ colposuspension)

Question 15

In whom is urinary retention with overflow incontinence more common

Answer 15

men due to BPH

Question 16

what is overflow incontinence

Answer 16

bladder outlet is too strong often due to blockage of the urethra

Question 17

classical features of overflow incontinence

Answer 17

poor urine flow, double voiding, hesitancy, post micturition dribbling

Question 18

how can we treat overflow incontinence

Answer 18

treat with alpha blocker, anti androgen, surgery (TURP)

results in catheterisation

Question 19

what is urge incontinence

Answer 19

bladder muscle is too strong

Question 20

classical features of urge incontinence

Answer 20

detrusor contracts at low volumes so you have a sudden urge to pass urine

Question 21

what can urge incontinence be due to

Answer 21

bladder stones or stroke

Question 22

how can we treat urge incontinence

Answer 22

treat with anti- muscarinics (ocybutinin, tolterodine, solfenacin) bladder retraining
beta-3 adrenoceptor agonists - mirabegron

Question 23

what is neuropathic bladder

Answer 23

underactive bladder secondary to neurological disease or prolonged catheterisation
you have no awareness that your bladder is filling and therefore get overflow incontinence

Question 24

treatment for neuropathic bladder

Answer 24

catheterisation is the only effective treatment

Question 25

when do you refer for urinary incontinence

Answer 25

after failure of initial management (max 3 month of pelvic floor exercises, cone therapy, habit retraining/appropriate meds) ``` must refer straight away- vesicovaginal fistula palpable bladder after micturition diseases of CNS gynaecologist conditions sever BPH or protastatic carcinoma those with previous surgery for incontinence issues faecal incontinence if suspected sphincter damage or neurological diseases ```

Question 26

what is delerium

Answer 26

an acute change in your mental state

Question 27

key features of delerium

Answer 27

disturbed consciousness, change in cognition, acute onset and fluctuation, disturbance of wake sleep cycle, disturbed psychomotor behaviour, emotional disturbance

Question 28

what is a common screening tool that we use for those with delirium?

Answer 28

4AT

Question 29

describe the 4AT

Answer 29

alertness- graded 0-4 Aware- LADY- location age DOB year 0-2 Attention- months of the year backwards 0-2 any acute changes 0-4

Question 30

how do we treat delerium

Answer 30

``` reorientate and reassurance for agitated patients try to include family and carers encourage early mobility and self care correction of sensory impairment normalise sleep wake cycle ensure continuity of care try to avoid hospitalisation stop certain drugs ```

Question 31

what are common drugs to increase falls

Answer 31

``` antihypertensives beta blockers sedatives anticholinergics opioids alcohol ```

Question 32

when do you need to get a CT after a fall

Answer 32

``` Low GCS <13 still confused after 2 hours focal neurology signs of skull fracture seizure vomiting anticoagulant ```

Question 33

what do we do after someone has fallen in hospital

Answer 33

repeat the risk assessment DATIX call family try and prevent further falls

Question 34

why are sedatives (Benzos and antipsychotics)

Answer 34

increased postural hypotension, stroke, confusion, movement disorders

Question 35

what is the risk with digoxin in elderly

Answer 35

increased toxicity so lower doses needed

Question 36

what happens with warfarin in the elderly

Answer 36

they are more sensitive to it so there is an increased risk of bleeds