Geris Flashcards by Bethany Smith

Define Delirium

State of confusion that develops quickly and fluctuates in intensity

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What are the features of delirium?

Acute onset
Fluctuating course
Inattention
Altered level of consciousness
Usually reversible
Associated w/ underlying medical cause

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What are the risk factors for delirium?

Dementia (x5)
Multiple comorbidities
Physical frailty
Older age
Sensory impairment

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What are some precipitating factors of delirium?

Drug initiation
Medical illness
Systemic infection
Metabolic derangement
Surgery
Pain
Stroke
Seizures
Systemic organ failure

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What are the different types of delirium?

Hyperactive
Mixed
Hypoactive

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What assessments can be used for delirium?

4-AT
CAM
AMT

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What are the 1st line Ix?

BLOODS - WBC + CRP (infection) / U&Es / LFTs / Glucose / TFTs
CXR
Urinalysis
ECG

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What are the 2nd line Ix?

BLOODS - serum calcium, B12 and folate
ABG
Blood / sputum culture
CT / MRI head
EEG
Toxicology screen
Bladder scan - retention
LP

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What are some causes of delirium?

Infection
Drug use - w/drawal / new meds
reduced sensory input - blind / deaf / changing environment
Intercranial problems - stroke / seizures / hemorrhage
Electrolyte imbalances
Constipation
Urinary retention
Heart problems - MI / arrhythmias

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How is delirium managed?

Treat underlying cause
- Dug review doe poly-pharmacy
- Analgesia
- Laxatives
- Abx for infection
- Correct electrolytes

Manage the environment
- Involve family
- Soft lighting
- Clocks and calendars
- Sleep hygiene
- Correct sensory impairment eg glasses / hearing aids
- Keep mobile and active
- Avoid multiple rooms + different staff
- Minimise provocation eg noise)

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What should you monitor in delirium?

Vital signs
Bowels
Nutrition
Hydration
Pressure areas
Electrolytes
Response to abx

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When do you use drugs in delirium?

What are the indications for drugs?

In tx failure

rapid tranquilsation of agitated pts where there is imminent risk of harm
short term control of distress

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What drugs do you use?

Haloperidol
Lorezapam (given in Parkinson’s / Lewy body dementia due to the EPSEs of haloperidol)

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What percentage of delirium patients never recover?

20%

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What are the consequences of falls?

Loss of confidence
Serious injury
Fragility fracture
Complications from long lie

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What are some environmental (extrinsic RFs) causes of falls in the elderly?

Polypharmacy
Bifocals
Walking aids
Home hazards - Loose rugs / Pets / Furniture etc
Unstable footwear

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What are some intrinsic risk factors for falls?

Female
Neurological disease
Cognitive decline
Muscle weakness

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What are some power / balance cause of falls in elderly people?

Inactivity leading to – muscle weakness
Dizziness/loss of balance/loss of proprioception (vertigo)
Pain/MS – osteoarthritis
Previous fall leading to decreased confidence

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What are some cardiovascular causes of falls in elderly people?

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Vasovagal syncope (fainting)
Situational syncope – e.g. micturition (old men, night time)
Postural hypotension
Myocardial infarction
Arrhythmia
Dehydration/shock

What are some neurological causes of falls in elderly people?

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Stroke
PD
Gait disturbance
Visual impairment
Peripheral neuropathy
Vertigo
Myopathy e.g. statin or steroid myopathy

What are some medications that increase risk of falls in elderly people?

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Beznodiazepines - sedative so impair coordination
Diuretics
Anti-hypertensives – ACEi, CCB, Beta blockers
Antidepressants
Antipsychotics
Polypharmacy

What are some other causes of falls in elderly people?

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Infection/sepsis
Delirium / Dementia
Hypoglycaemia
Incontinence
Alcohol – intoxication, neuropathy, Korsakoff’s/Wernicke’s

Falls are the leading cause of _____ and are associated with increased ________

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Falls are the leading cause of fractures and are associated with increased mortality

Falls lead to a loss of ________ + __________

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Falls lead to a loss of confidence + independence

Define frailty

State of increased vulnerability resulting from ageing associated decline in functional reserve Across multiple physiological systems Resulting in compromised ability to cope with everyday or acute stressors

What is the impact of frailty on elderly people and how does it change how they need to be cared for?

Different type of doctor – geriatricians are experts in frailty Poor functional reserve – trivial insult to a younger person has a large impact on an older person Failure to integrate responses in the face of stress Vulnerable to decompensation when faced with illness, drug side effects and metabolic disturbance

Frailty correlates with increasing ___, _____ + _____

Frailty correlates with increasing age, disease + disability

What is the Frailty Phenotype as defined by the Fried model?

The presence of 3 or more of: - Unintentional wt loss - Weakness evidenced by poor grip strength - Self reported exhaustion - Slow walking speed - Low level of physical activity

What are individuals w/ one or 2 characteristics classed as?

Pre-frail

What is phenotypic frailty predictive of?

A higher risk of falls, hospitalisation, disability + death

What is the frailty index?

A count of health deficits IE - the more deficits the frailer the person and the greater the risk of deterioration and death

What is the best known frailty index?

Rockwood Frailty Index

What counts as a deficit in the frailty index? How are they weighed?

Symptoms / Signs / Diseases / Disabilities / Ix findings Each one is weighed the same

How is the Ratio calculated? (frailty index)

Number or deficits / Total number of deficits considered

What is the limitation of the frailty index?

Detailed measurements and collation of pt data is needed.

What are physiological markers of frailty?

Increased inflammation - EG CRP / IL6 / Factor VIII + Fibrinogen Elevated insulin and glucose levels in fasting state Low albumin Raised D dimer and alpha anti-trypsin Low Vit D levels

What are the different categories on the Frailty index?

Very fit Well Managing well Vulnerable Mildly frail Moderately frail Severely frail Very seriously frail Terminally ill

What does Very Fit mean on the Frailty index?

Very fit = <0.09 – robust, active, energetic, motivated

What does Well mean on the Frailty index?

Well – no active disease and exercise occasionally

What does Managing Well mean on the frailty index?

Managing well – medical problems are well controlled but not regularly active beyond walking

What does Vulnerable mean on the frailty index?

Vulnerable – symptoms limit activities, tired during day

What does Mildly Frail mean on the frailty index?

Mildly frail = 0.27 – need help for high order ADLs e.g. finance

What does Moderately Frail mean on the frailty index?

Moderately frail – need help with house keeping and bathing

What does Severely Frail mean on the frailty index?

Severely frail = 0.42 – completely dependent for personal care, not at high risk of dying

What does Very Seriously Frail mean on the frailty index?

Very seriously frail – completely dependent, approaching end of life

What does Terminally Ill mean on the frailty index?

Terminally ill – life expectancy <6 months but may not be evidently frail

What are some interventions for frailty?

Physical activity (Exercises focusing on strength and balance) Protein-calorie supplementation Vit D supplements Minimisation of polypharmacy to reduce risk of frailty

Geris Flashcards

(47 cards)