Geriatrics Flashcards
(35 cards)
What are the symptoms of hyperactive delirium?
Confusion/disorientated, motor agitation, restlessness, aggression, hallucinations
What are the symptoms of hypoactive delirium?
Confusion/disorientated, motor retardation, apathy, slowing of speech, appear sedated, hallucinations
What are the common causes of delirium?
Pain, infection, nutrition, constipation, hydration, medication, environment (PINCH ME)
What are the risk factors for developing delirium?
Old age, dementia, sensory impairment, change of environment, sleep deprivation
How can you diagnose delirium?
Collateral history, MMSE
How can you differentiate delirium from dementia?
Delirium has sudden onset and fluctuates over days to weeks, variation in consciousness, impaired attention, psychomotor changes
What is involved in a delirium screen?
FBC, U+E, LFTs, TFTs, B12, folate, calcium, magnesium, syphilis serology, urine dipstick/MC+S, CXR
How do you treat agitation caused by delirium?
Haloperidol 0.5mg PO or IM= 1st line
Lorazepam = 2nd line
But try modifying the environment and reassurance/escalating techniques first
What are the risk factors for developing Alzheimer’s?
Early onset = autosomal dominant disease, Down’s syndrome
General = insulin resistance, high cholesterol, family history, hypothyroid, depression, HIV, Parkinson’s
What is the pathophysiology of Alzheimer’s?
General atrophy of brain tissue with frontal and temporal lobes being most affected (temporal will show first signs)
Amyloid plaques and Tau protein deposition in cortex
What are the features of vascular dementia?
Occurs in patients that have had strokes/hypertension/heavy smokers etc. due to multiple small infarcts in brain
Stepwise progression where there is period of stability followed by acute decline
What are the features of Lewy body dementia?
Vivid visual hallucinations, Parkinsonism (cognitive decline will precede this), sleep disorders, fluctuating cognition
What are the features of Fronto-temporal dementia?
Often family history
More common in people under 65
Changes in personality and behavior
What medications can be used in Alzheimer’s?
Donepezil (1st line if mild-to-moderate)
Memantine (1st line if moderate to severe)
Only initiate drug therapy in those with MMSE >12 as otherwise side effects will likely outweigh benefits
How is vascular dementia treated?
Reduce vascular risk factors - aspirin/warfarin, BP control
How is Lewy body dementia managed?
1st line = donepezil, rivastigmine
What medications can increase risk of falls?
Laxatives - urgency to go to toilet
Pain killers - can cause confusion
Diuretics/antihypertensives- drop in BP and postural hypotension
Benzodiazepines - cause sedation
What are some common causes of falls?
Postural hypotension, infection, cognitive impairment, hypoglycaemia, peripheral neuropathy, anaemia, dehydration, electrolyte abnormalities, chronic alcohol use, hearing/visual issues, environmental hazards, polypharmacy
What is the definition of postural hypotension?
Systolic drop >20mmHg when going from sitting to standing
Measure BP at 1 min and 3 min after standing
What medications can cause postural hypotension?
Nitrates, diuretics, anticholinergic, antidepressants, beta blockers, l-dopa, ACE inhibitors
What is the definition of a fragility fracture?
Fractures that result from mechanical forces that would not ordinarily result in fractures i.e. standing height or less
What are the risk factors for fragility fractures?
Increasing age, female, low body mass, steroid therapy, Cushing’s syndrome, excessive alcohol intake, falls
What is the definition of frailty?
A distinct health state characterised by a reduction in physiological reserve resulting in adverse outcomes following minor stressor events such as fall or infection
How can you manage frailty?
Regular review of medications, assess physical and mental health needs, address any risk factors for falls, create personalised care plan, support them to eat well
