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Year 3 - Exams > Introduction to Geriatric Medicine Lecture > Flashcards

Introduction to Geriatric Medicine Lecture Flashcards

1
Q

What is gerontology?

A

Science of ageing

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2
Q

What proportion of people >75 arre in care homes?

A

7%

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3
Q

90 year-old lady with drowsiness and vomiting

  • HxOA, HTN, dementia
  • Rx: Amlodipine, Omeprazole
  • Chest clear, abdomen SNT
  • Severe AKI–CRP 11. Urine dip WC+, nit
  • Initial CT Brain: age-related atrophy
  • IVI, Broad spectrum antibiotics, USS Abdo
  • AKI resolving with fluid and cessation of Rx
  • USS was normal
  • Vomiting persists

Likely underlying diagnosis?

  • –A: Bacterial gastroenteritis
  • –B: Drug side-effect
  • –C: UTI
  • –D: Viral encephalitis
  • –E: Viral gastroenteritis
A

B - drug side effect, constipation from amlodipine

Intervention –>PR examination, enema, macrogol, medication review

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4
Q
A
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5
Q

Define frailty.

A

Frailty = a physiological syndrome characterised by decreased reserve and resistance to stressors, resulting from cumulative decline in multiple physiological symptoms, causing vulnerability to adverse outcomes.

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6
Q

List some factors that contribute to frailty.

A

Increased likelihood of adverse events and deterioration when they face minor stressors is due to these factors:

(Escpecially starting at a lower physiological reserve)

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7
Q

What is the CGA?

A

Comprehensive geriatric assessment (CGA) - Multidimensional interdisciplinary assessment that leads to individualised, goal based plan.

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9
Q

Who does the CGA benefit most? What are the benefits of using CGA in the community and hospital?

A
  • CGA in the community
    • Reduce admissions to institutional care
    • Reduce falls
    • Most benefit in mild or moderate frailty
  • CGA for frail inpatients
    • Reduces inpatient mortality
    • Reduces functional and cognitive decline
    • Reduces admission to institutional care
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10
Q

What are the two theories of why organisms age?

A
  • Damage or error theories
  • Programmed ageing theories
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11
Q

Describe the “damage or error” theory of ageing,

A
  • Cause of ageing is the damage to DNA, cells and tissues e.g. loss of telomeres or oxidative damage.
  • The theory holds that if we could prevent or repair this damage then we could prevent ageing
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12
Q

Describe the programmed ageing theory.

A
  • Genetic, hormonal and immunological changes over the lifetime of an organism lead to cumulative deficits we see as ageing
  • These theories of programmed ageing suggest that this is an inescapable part of a biological timetable just as growth and puberty are programmed to occur.
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13
Q

What are the main difficulties when managing disease in the elderly?

A
  • Non-specific presentations
  • Polypharmacy - with increasing drug use there are more drug interactions. Most drug evidence is extrapolated from young people.
  • Multimorbidity - conditions impact on one another and treatment for one condition may impact another.
  • Rehabilitation
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14
Q

Why do older people take more drugs?

A
  • Multimorbidity
  • Guidelines/QOF/NICE
  • Undetected non-adherence – e.g. antihypertensives; patient doesn’t take it but you do not realise so you prescribe another
  • Infrequent review
  • Poor communication
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15
Q

What percentage of prescriptions are potentially inappropriate?

A

Up to 40%

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16
Q

What are the risk of polypharmacy in the elderly?

A
  • Falls
  • Increased length of stay
  • Delirium
  • Mortality
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17
Q

What changes can be seen in the brains of the elderly on MRI/CT?

A
  • volume of cerebral spinal fluid within the surrounding brain increases with age
  • ventricles enlarge
  • gaps between the major gyri widen
18
Q

When does the brain start to age and at what rate?

A
  • Brain is at max weight at age 20
  • At 40-50 years it decreases in weight at rate of 2-3% per decade
  • At 80 years it is about 10% below maximum weight
19
Q

What are the normal cognitive changes in older people?

A
  • Processing speed slows
  • Working memory slightly reduced
  • Simple attention ability preserved, but reduction in divided attention
  • Executive functions generally reduced
20
Q

What cognitive aspects do not change with age?

A
  • No change in nondeclarative memory
  • No change in visuospatial abilities
  • No overall change in language (some reduction in verbal fluency)
21
Q

Why are rates of diagnosis of dementia low?

A
  • Misinterpretation (it is normal for older people to have poor memory)
  • Fatalism (we can’t do anything about it so what is the point of diagnosing)
  • Social isolation - no one is there to notice the problems

Only 70% of people with dementia have a diagnosis.

22
Q

What is dementia?

A

A chronic, progresive, degenerative disease which cause a decline in all domains of cognition.

23
Q

What are the cognitive changes in dementia?

A
  • Memory impairment but also:
  • Loss of executive function
  • Functional impairment
  • Behavioural and psychological changes
  • Lack of insight

Starts with memory problems but over time affects all cognitive functions.

24
Q

What is deliriium?

A
  • Acute global failure of higher brain functions (i.e. affecting alertness and cognition)= ACUTE BRAIN FAILURE.
  • Delirium is an acute episode of confusion, usually with a clear precipitant such as infection or medication changes. Delirium usually resolves, but can leave some people with residual problems (ie dementia).
25
Q

List the differences between dementia and delirium.

A
27
Q

What are the main two components of higher brain function?

A
  • Alertness - level of consciousness
  • Cognition - content of consciousness
28
Q

List 3 common causes of “confusion”

A
  • Delirium
  • Dementia
  • Deafness - often mistaken for confusion
29
Q

What are the key issues involved with cognitive assessment of older adults?

A
  • Hearing and visual impairment may limit testing
  • Physical problems may limit testing
  • Most assume numeracy and literacy
  • Most assume some basic cultural knowledge
  • Depression can masquerade as dementia
  • Not valid in acute illness
  • Normal cognitive changes (slower processing speed, slower reaction times) may affect administration
30
Q

Give examples of some screening tests used in the cognitive assessment of the elderly?

A

Screening tests

  • AMT, clock drawing test, 4AT, GP COG, 6CIT…
  • Mini Mental State Examination (MMSE)
  • Montreal Cognitive Assessment (MOCA)
31
Q

Give 2 examples of diagnostic tests used in the cognitive assessment of the elderly.

A
  • Addenbrooke’s Cognitive Examination (ACE)
  • Detailed neuropsychometric testing
32
Q

Which tests are used for brief screening of cognitive impairment? Which are used for more detailed cognitive assessments?

A

Abbreviated Mental Test (AMT) and clock drawing tests = brief screening tests for cognitive impairment.

Montreal Cognitive Assessment (MOCA) and Mini Mental State Examination (MMSE) are used for more detailed examination (MMSE is out of date now)

33
Q

Which screening tests help you distinguish betwen delirium and dementia?

A

Confusion Assessment Method (CAM) and 4AT

34
Q

What are the advantages of MOCA?

A
  • Covers variety of domains of cog. function
  • Brief
  • Validated in many populations
  • Translated versions available
35
Q

What are the disadvantages of MOCA?

A
  • Education level and language level affects results
  • Floor and ceiling effects
  • Can be poorly administered
  • Possible practice/coaching effects
36
Q

What are the main parts of a CAM assessment?(4)

A
  1. Acute onset and fluctuating course
  2. Inattention - distractable
  3. Disorganised thinking - “rambling”
  4. Altered level of consciousness - drowsy/hypervigilant

Must have 1 and 2

Then 3 or 4

37
Q

List some common causes of delirium?

A
  • Hypoxia
  • Anticholinergic drugs
  • Constipation
  • Urosepsis
  • Change of environment
  • Withdrawal from sedatives /alcohol / analgesia
38
Q

Which drugs have opposite effects to dementia drugs? What is the main complication?

A

Cholinesterase inhibitors (Dementia drugs) increase ACh

Many drugs have anticholinergic properties

  • Bladder antispasmodics (egoxybutynin)
  • Tricyclic antidepressants (egamitryptilline)
  • Furosemide
  • Digoxin
  • Cyclizine

LOTS MORE! Google “AntiCholinergicBurden ACB” - this can cause delirium

39
Q
A

Year 3 - Exams (25 decks)

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