Session 2

Question 1

1. Frailty is?

Answer 1

1. loss of biological reserves and vulnerability to adverse outcomes

a common clinical syndrome in older adults that carries an increased risk for poor health outcomes e.g. falls, incident disability, hospitalization, & mortality .

Question 2

How do you measure frailty

Answer 2

Question 3

What is the graph showing

Answer 3

Age, electronic frailty index score and mortality

Question 4

1. Sarcopenia:
2. Sarcopenia is a component of?

Answer 4

1. degenerative loss of skeletal muscle mass (0.5–1% loss per year after the age of 50), quality, and strength associated with aging
2. frailty syndrome - elevated risk of declines in health and function among older adults

cachexia/wasting syndrome - loss of weight, muscle atrophy, fatigue, weakness, & significant loss of appetite in someone who is not actively trying to lose weight.

Question 5

Cachexia is seen in people with?

Answer 5

cancer, AIDS, coeliac disease, chronic obstructive pulmonary disease, multiple sclerosis, rheumatoid arthritis, congestive heart failure, tuberculosis, familial amyloid polyneuropathy, mercury poisoning (acrodynia), Crohn’s disease, untreated/severe type 1 diabetes mellitus, anorexia nervosa, and hormonal deficiency.

Question 6

1. Osteopaenia:

Answer 6

1. bone mineral density is lower than norma

Question 7

Sarcopenia refers to loss of muscle mass and low muscle function (strength or performance) that occurs as a result of old age. It is characterized first by a decrease in muscle mass, which causes weakness and frailty. However, this loss of muscle mass may be caused by different cellular mechanisms than those that cause muscle atrophy. For example, during sarcopenia, there is a ?

Answer 7

replacement of muscle fibres with fat and an increase in fibrosis

Question 8

What are the four key features in geriatric patients?

Answer 8

• Non-specific presentations
• Homeostatic failure
• Multiple pathology & polypharmacy
• Differential challenge

Question 9

Moderate to severe frailty strongly associated with non-specific presentations -> give e.g. of non-specific presentations

Answer 9

• Falls, immobility, off legs, collapse ? cause
• Confusion (delirium and/or dementia)
• “Acopia” or “social admission” (phrases never to use!)
• Other diffuse or multiple statements related to disability

Question 10

The natural ageing process means that older people have an increased risk of having a fall. In the UK, falls are the most common cause of injury related deaths in people over the age of 75.

Older people are more likely to have a fall because they may have:

Answer 10

• balance problems and muscle weakness
• poor vision
• a long-term health condition, such as heart disease, dementia or low blood pressure (hypotension), which can lead to dizzinessand a brief loss of consciousness

Question 11

Difference between dementia and delirium i.e. causes, onset,

Answer 11

Osteoporosis

Question 12

Acopia

Answer 12

patient’s inability to cope with activities of daily living

Question 13

Delirium

There are several medical definitions of delirium (including those in the DSM-IV and ICD-10). However, all include some core features.

The core features are:

Answer 13

Disturbance of consciousness (that is, reduced clarity of awareness of the environment, with reduced ability to focus, sustain, or shift attention)

Change in cognition (e.g., problem-solving impairment or memory impairment) or a perceptual disturbance (hallucination)

Onset of hours to days, and tendency to fluctuate.

Behaviour may be either overactive or underactive, and sleep is often disturbed, with loss of the normal circadian rhythm.

Thinking is slow and muddled but the content is often complex.

Question 14

The most common causes of sudden confusion are:

Answer 14

a lack of oxygen in the blood (hypoxia) – the cause could be anything from a severe asthma attack to a problem with the lungs or heart

an infection anywhere in the body, especially in elderly people

a stroke or TIA (“mini stroke”)

a low blood sugar level (hypoglycaemia)

diabetic ketoacidosis, a serious complication of diabetes caused by a lack of insulin in the body

certain medications, including digoxin, diuretics, steroids, and opiates

alcohol poisoning or alcohol withdrawal

drug misuse

Question 15

what do they mean by Homeostatic failure

Answer 15

• Balance, temperature, blood pressure, sodium, etc
• Biological systems usually robust: multiple feedback loops
• Failure either due to overwhelming single disease, or lesser disease with multiple co- morbidity

Question 16

How and why does balance change with age?

Question 17

How and why does temperature change with age?

Question 18

How and why does bp change with age

Question 19

What does it mean by pathology?

Answer 19

• Cognitive impairment
• Iatrogenesis
• Deafness and blindness
• Axial osteoarthritis
• Vascular (cerebral, cardiac, renal, peripheral)
• Diabetes
• Respiratory disease
• Depression

Question 20

Iatrogenesis

Answer 20

any effect on a person, resulting from any activity of one or more persons acting as healthcare professionals or promoting products or services as beneficial to health, that does not support a goal of the person affected

Question 21

Some iatrogenic effects are clearly defined and easily recognized, such as a complication following a surgical procedure (e.g., ? as a result of breast cancer surgery). Less obvious ones, such as complex drug interactions, may require significant investigation to identify.

Answer 21

lymphedema

Question 22

While some have advocated using ‘iatrogenesis’ to refer to all ‘events caused by the health care delivery team’, whether ‘positive or negative’, consensus limits use of ‘iatrogenesis’ to adverse effects, possibly including, broadly, all adverse unforeseen outcomes resulting from medication or other medical treatment or intervention.

Cases of iatrogenesis include:

Answer 22

side effects of possible drug interactions

complications arising from a medical procedure or treatment

medical errors

negligence

use of contaminated instruments

anxiety or annoyance in the physician or treatment provider in relation to medical procedures or treatments

unnecessary medical treatment resulting from a physician’s decision

Question 23

Osteoarthritis (OA) is a type of joint disease that results from breakdown of joint cartilage and underlying bone.[5] The most common symptoms are joint pain and stiffness.[1] Initially, symptoms may occur only following exercise, but over time may become constant.[1]Other symptoms may include joint swelling, decreased range of motion, and when the back is affected weakness or numbness of the arms and legs.[1] The most commonly involved joints are those near the ends of the fingers, at the base of the thumb, neck, lower back, knee, and hips.[1] Joints on one side of the body are often more affected than those on the other.[1] Usually the symptoms come on over years.[1]It can affect work and normal daily activities.[1] Unlike other types of arthritis, only the joints are typically affected.[1]

Question 24

Vulnerable homeostatic systems need protection from challenge…..but…

Answer 24

• Living alone
• Poverty
• Poor housing
• Ageism

Question 25

What is a seizure?

Answer 25

short episode of symptoms caused by a burst of abnormal electrical activity in the brain

Question 26

What is a seizure?

Answer 26

short episode of symptoms caused by a burst of abnormal electrical activity in the brain

Question 27

If you have epilepsy, it means ?

Answer 27

you have had repeated seizures.

Question 28

Seizures are divided into two main types -

Answer 28

generalised and focal

Question 29

Generalised seizures (abnormal electrical activity affects all or most of the brain) The symptoms tend to be general and involve much of your body.

There are various types of generalised seizure:

Answer 29

A tonic-clonic seizure is the most common type of generalised seizure. With this type of seizure your whole body stiffens, you lose consciousness and then your body shakes (convulses) due to uncontrollable muscle contractions.

Absence seizure is another type of generalised seizure. With this type of seizure you have a brief loss of consciousness or awareness. There is no convulsion, you do not fall over and it usually lasts only seconds. Absence seizures mainly occur in children.

Question 30

Focal seizures

In focal seizures the burst of electrical activity starts in, and stays in, one part of the brain. Therefore, you tend to have localised (focal) symptoms. Different parts of the brain control different functions and so symptoms depend on which part of the brain is affected:

Answer 30

Simple focal seizures are one type. You may have muscular jerks or strange sensations in one arm or leg. You may develop an odd taste, or pins and needles in one part of your body. You do not lose consciousness or awareness.

Complex focal seizures are another type. These commonly arise from a part of the brain (called a temporal lobe) but may start in any part of the brain. Therefore, this type is sometimes called temporal lobe epilepsy. Depending on the part of the brain affected, you may behave strangely for a few seconds or minutes. For example, you may fiddle with an object, or mumble, or wander aimlessly. In addition, you may have odd emotions, fears, feelings, visions or sensations. These differ from simple focal seizures in that your consciousness is affected. You may not remember having a seizure.

Question 31

What causes epilepsy?

Answer 31

• idiopathic epilepsy
• Symptomatic epilepsy (brain condition or brain damage):

A patch of scar tissue in a part of the brain.

A head injury.

A stroke.

Cerebral palsy.

Some genetic syndromes.

Growths or tumours of the brain.

Previous infections of the brain such as meningitis and encephalitis.

Question 32

What triggers a seizure?

Answer 32

Possible triggers may include:

Stress or anxiety.

Some medicines such as antidepressants, antipsychotic medication (these lower the seizure threshold in the brain).

Lack of sleep, or tiredness.

Irregular meals (or skipping meals) which may cause a low blood sugar level.

Heavy alcohol intake or using street drugs.

Flickering lights such as from strobe lighting or video games.

Periods (menstruation).

Illnesses which cause high temperature (fever) such as flu or other infections.

Question 33

How is epilepsy diagnosed?

Answer 33

A brain scan - usually a magnetic resonance imaging (MRI) scan or computed tomography (CT) scan - shows the structure of different parts of the brain. This may be performed in some people.

Electroencephalograph (EEG). This test records the electrical activity of the brain. Special stickers are placed on various parts of the scalp. They are connected to the EEG machine. This amplifies the tiny electrical messages given off by the brain and records their pattern on paper or computer. The test is painless. Some types of seizure produce typical EEG patterns. However, a normal recording does not rule out epilepsy and not all EEG abnormalities are related to epilepsy.

Blood tests and other tests may be advised to check on your general well-being. They may also look for other possible causes of the event.

Question 34

Treatments include:

Answer 34

medicines called anti-epileptic drugs (AEDs)

surgery to remove a small part of the brain that’s causing the seizures

a procedure to put a small electrical device inside the body that can help control seizures

a special diet (ketogenic diet) that can help control seizures

Question 35

There are many AEDs.

Common types include:

Answer 35

sodium valproate

carbamazepine

lamotrigine

Question 36

Surgery to remove part of your brain may be an option if:

Answer 36

AEDs aren’t controlling your seizures

tests show that your seizures are caused by a problem in a small part of your brain that can be removed without causing serious effects

Question 37

What is a Ketogenic diet

Answer 37

diet high in fats, and low in carbohydrates and protein. In children, it’s thought it may make seizures less likely by changing the levels of chemicals in the brain

Question 38

It’ll help your specialist if you can describe what you remember about your seizure in as much detail as possible, including things like:

Answer 38

when you had the seizure

what you were doing when it happened

how you felt before, during and afterwards

Question 39

Tests for epilepsy:

Answer 39

• Electroencephalogram (EEG) is used to check for unusual electrical activity
• Magnetic resonance imaging (MRI)

an unusual growth (brain tumour)

damage to the brain, such as damage caused by a stroke

scarring in the brain

Question 40

Simple partial (focal) seizures or ‘auras’

A simple partial seizure can cause:

Answer 40

a general strange feeling that’s hard to describe

a “rising” feeling in your tummy – like the sensation in your stomach when on a fairground ride

a feeling that events have happened before (déjà vu)

unusual smells or tastes

tingling in your arms and legs

an intense feeling of fear or joy

stiffness or twitching in part of your body, such as an arm or hand

Question 41

Complex partial (focal) seizures

During a complex partial seizure, you lose your sense of awareness and make random body movements, such as:

Answer 41

smacking your lips

rubbing your hands

making random noises

moving your arms around

picking at clothes or fiddling with objects

chewing or swallowing

You won’t be able to respond to anyone else during the seizure and you won’t have any memory of it.

Question 42

Who is palliative care for?

Answer 42

• have an advanced incurable illness such as cancer, dementia or motor neurone disease
• are generally frail and have co-existing conditions that mean they are expected to die within 12 months
• have existing conditions if they are at risk of dying from a sudden crisis in their condition
• have a life-threatening acute condition caused by a sudden catastrophic event, such as an accident or stroke

Question 43

What is palliative care?

Answer 43

End of life care includes palliative care. If you have an illness that can’t be cured, palliative care makes you as comfortable as possible, by managing your pain and other distressing symptoms. It also involves psychological, social and spiritual support for you and your family or carers. This is called a holistic approach, because it deals with you as a “whole” person.

Question 44

Medications and treatments are said to have a palliative effect if they ?

Answer 44

relieve symptoms without having a curative effect on the underlying disease or cause. This can include treating nausea related to chemotherapy or something as simple as morphine to treat the pain of broken leg or ibuprofen to treat pain related to an influenza infection.

Question 45

Achieving a ‘good death’ – the challenges:

Answer 45

• Truthfulness(honest/open)with patients
• Enabling informed consent
• Allowing time to prepare
• Avoiding isolation
• Overcoming a wall of silence
• Maintaining hope by accompanying them on the journey

Question 46

Facilitate movement through Psychological stages of Dying - so-called anticipatory grief
• Anger • Denial • Bargaining • Depression • Overall the alteration in life dynamics, coping with potential loss,
changes in role & image • Acceptance or Resignation? • (Kubler-Ross)

Question 47

What are the Principles of a ‘good death?

Answer 47

• To be warned when death is coming & learn what can be expected
• To be able to retain control of what happens
• To be afforded dignity and privacy
• To have control over pain relief and other symptom control
• To have choice and control over where death occurs (at home or elsewhere)

Question 48

1. What is Morphine?
2. Uses
3. side effects:

Answer 48

1. strong painkiller
2. -MI
   - labour
   - post op

(end of life care)

3. Common: - constipation - feeling and being sick

Serious: decreased respiratory effort and low blood pressure

Question 49

Answer 49

• record the person’s details and the date
• explore and enhance their understanding of their condition & summarise relevant detail
• record details of other planning documents
• help them to identify priorities for their care
• help them to identify what is important to them (if they want to)

Question 50

Answer 50

the main focus of treatment

•specific types of care and treatment

▫ that the person would or would not want

▫ that would not work in their situation

•whether or not attempted CPR is

recommended

Question 51

Answer 51

ReSPECT — Review

•The recommendations on the form should be reviewed:

▫ if the person or those close to them requests this

▫ if the person’s condition changes

▫ if the person moves from one care setting to another
(including in-hospital transfer e.g. to or from ICU)