S2: ageing, dementia & falls in older patients

Question 1

Describe how the respiratory system is affected by ageing

Answer 1

Lung and chest wall compliance decreases, as well as TLC, FVC, FEV1 & vital capacity
-occur because of a reduction in elastic support of the airways -> increased collapsibility of alveoli and terminal conducting airways
Atelectasis, pulmonary emboli and pneumonia are common post-operative complications in the elderly

Question 2

Describe how skin is affected by ageing

Answer 2

Thin skin and fragile subcutaneous blood vessels -> patients tend to bruise easily
Achieving and securing venous access can be difficult

Question 3

Describe how the cardiovascular system is affected by ageing

Answer 3

Large and medium sized vessels become less elastic -> less compliant -> raised systemic vascular resistance and hypertension
Cardiac conducting cells decrease in number making heart block, ectopic beats, arrhythmias & AF more prevalent
CO falls -> IV anaesthesia is achieved more slowly

Question 4

Describe how the renal system is affected by ageing

Answer 4

GFR decreases by 1% per year over the age of 20 years due to a progressive loss of renal cortical glomeruli
Reduced renal perfusion due to reduced CO
Diabetes mellitus is increasingly common, as is use of nephrotoxic drugs

Question 5

Describe how the CNS is affected by ageing

Answer 5

CNS disease is common -> diffuse atherosclerosis and hypertension
Neuronal density is reduced by 30% by the age of 80

Question 6

Outline the endocrine and metabolic effects of ageing

Answer 6

Basal metabolic rate falls by 1% per year after the age of 30
Fall in metabolic activity and reduced muscle mass may cause impaired thermoregulatory control

Question 7

Define malnutrition

Answer 7

Any condition caused by an in-balance between what an individual eats and what that individual requires to maintain health

Question 8

Describe the sequelae of malnutrition in the elderly

Answer 8

Likely to have longer hospital admissions

Respond less well to treatment, 3 times more likely to develop complications after surgery & have higher mortality rates

Question 9

Describe screening for malnutrition

Answer 9

One of the only recognised evidence-based tool is the malnutrition universal screening tool (MUST)
Tool can be used in hospital or in community setting

Question 10

Compare syncopal vs non-syncopal falls

Answer 10

Syncope: transient loss of consciousness due to reduced cerebral blood flow
Non-syncope: with or without loss of consciousness, not due to cerebral hypoperfusion

Question 11

List the different types of syncopal falls

Answer 11

Neurocardiogenic (vasovagal syncope)
Orthostatic hypotension
Cardiac arrhythmia
Structural cardio-pulmonary

Question 12

List the different types of non-syncopal falls

Answer 12

Without impairment of consciousness: 
1) Fall
2) Psychogenic 
3) TIA/stroke 
With partial or complete loss of consciousness:
1) Epilepsy 
2) Metabolic (hypoglycaemia, hypoxia, hypocapnia)
3) Intoxications

Question 13

List differentials for falls

Answer 13

Trip
UTI
Aortic stenosis
Hip osteoarthritis 
Brain mets 
Heart failure 
(NB: there are lots, this list is just a few examples)

Question 14

Describe history taking for a fall

Answer 14

Who – did anyone else see? Take a collateral history if yes
When – when did it happen, what were they doing at the time
Where – at home or elsewhere
What – before, during, after
How – how long were they on the floor? How many times has this happened?