Older Persons Flashcards
define CGA
the comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary, diagnostic process to determine the medical, psychological and functional capabilities of a frail older person ins order to develop a coordinates and integrrated plan for treatment and long term follow up
what are teh mian components of a CGA?
- problem list: current and past
- medication review;
- nutritional status
- mental health: cognition, mood and anxiety, fears
- functional capacity: basic activites of daily livin, gait and balance, activity/exercise status, instrumental activites of daily living
- social circumstances: informal support from family and freinds, social network, eligibility for being offered care resources
- environment: home environment, facilities and safety wihtin the home environment, transport, accessibility to local resources
what is polypharmacy?
polypharmacy is when 6 or more drugs are prescirbed at once (common in older persons)
how can you ensure safe prescribing in odler persons?
- correct agent is prescribed for correct patient with correct diagnosis
- check for allergies
- check for potnetials interactions wit other durgs
- use generic drug names and write in CAPITALS + dont use abbreviations
- ensure dose, frequency and times, and route of administration is clearly indentified
= always ensure to revidew medications on daily basis and stop meds which are not needed
what is the definition of frailty?
clincially recognisable state of increased vulnerability resulting from ageing associated decline in reserve and function across multiple phsyiologic systems such that ability to cope with everyday or acute strressors is comprised
= low grip strenght, low eenrgy, slowed walking speed, low physical activity, and/or unintentional weight loss
what is the clinical frailty scale?
1-9 ranging from very fit to terminally ill
a way to summarize the overall level of fitness or frailty of an older adult after they had been evaluated by an experienced clinician (look up the scale)
what are teh 5 I’s of geriatrics (aka geriatric giants)
Immobility Instability Incontinence Impaired memory Iatrogenesis
what is teh STOPP/START tool for safe prescribing?
Polypharmacy and inappropriate prescribing are well known risk factors for adverse drug reactions
(ADRs), which commonly cause adverse clinical outcomes in older people
STOPP/START tool used to identify potential patient safety incidents for those on multiple medicines or with long term conditions
STOPP - Screening Tool of Older Persons’ Prescriptions
START - Screening Tool to Alert to Right Treatment
name some of the main clinical conditions in older persons (main geriatric syndromes)
- falls
- confusion
- chronic pain
- depression
- incontinence/constipation
- delirium / dementia
- blackout/collapse
0 fatgue - weigh tloss
- frailty
- slow gati
how can falls be categorised?
syncopal and non syncopal
syncopal = blackout therefoe cardiovascualr or neurogenic cause
pre syncope is the feeling of losing consciousness without blacking out
non syncopal - trip/slip so asses gait/footwear and joints
what are some important questions to ask when an odler person has had a fall?
- what were they doing?
- how did the fall happen?
- did they blackout?
- how did they feel before the fall? dizzy/lightheaded/viusual problems
- cardiac symptoms?
- are they weak anywhere?
- has this happened before?
- medications that they’re on?
- how do they normally mobilise?
what examinations should be done after an older person falls?
- ECG
- lying and standing BP
- bloods
- CT head (if GCS 13 and below)
- cardio and neuro exam
- MSK exam to assess joints
- functional assessment of mobility
what is delirium?
delirium is an acute confusional state, with a sudden onset and fluctuating course - develops over 1-2 days and is recognised by chnage in consiousness either hyper (agigated and confused) or hypoalert (withdrawn and drowsy) and inattention
what can delirium be cuased by?
underlying medical problem, substance intoxications, substance withdrawal or a combo of all
commmon in older persons in hospital, frailer patients, have sensory impairment, cognitive impairment, those having surgery, have severe infections
important to exlcude: infection, electrolyte imbalance, hypoxia, drugs including opiates, urinary retention, constipation and uncontrolled pain
iwhat is delirium usually associated with?
- increased mortality
- prolonged hospital admission
- higher complication rates
- institutionalisation
- icnreased risk of developing dementia
how is delirium managed?
managed with supportive care by treating underlyign cause and orientating them to time and palce
pharm treatment only for extreme cases where patient is at signifcant risk to themelves or others
how do you assess mental capacity in a patient?
To have capacity a person must be able to :
- Understand the information relevant to the decision
- To retain that information
- To weigh that information as part of the process of making a decision
- To communicate his/her decision
what is dementia?
dementia is a progressive decline is cognitive function (occuring over months) affecting different areas of function including: retaining new info, managing complex tasks, language and word finding difficulty, behviour, orientation, recognition, ability to selfcare, reasonign
what are the mian types of dementia?
- alzheimers dementia: most common, slow progression, behavioural problmes common, diagnosed on Hx
- vascualr dementia: second most common, diagnosed on Ix, step wise progression
- lewy body dementia: gradually progressive, auditory or visual hallucinations, delusions well formed and persistent, parkinsonism present
- parkinsons disease with dementia: parkinsons ysmptoms precede confusion by over a year
- frontotemporal dementia: early onset, comples behavioural problems, language dysfunction
- mixed dementia: alzheimers and vascualr type
are patients with dementia able to make decisions regarding their care?
yes, patients are still able to if they have to right level of mental capacity
treatment for alzheimers?
cholinesterase inhibitors to slow progression
