The elderly Flashcards
(41 cards)
What is frailty
Reduced ability to withstand illness without loss of function
What is ageing
Progressive accumulation of damage to complex system resulting in aggregate loss of system redundancy
What is frailty phenotype?
3 of 5 criteria Unintentional weight loss exhaustion Weak grip strength Slow walking speed Low physical activity
What is HIS think frailty?
Functional impairment Resident in care home Acute confusion Immobility or falls List of 6+ medicines
What are examples of health domains?
Medical Psychological Functional Behavioural Nutritional Spiritual Social
What is a comprehensive geriatric assessment
Process to assess and manage illness in older people with frailty
What are key features of delirium?
Disturbed consciousness
Change in cognition
Acute onset and fluctuant
What are the consequences of delirium?
Increased risk of death, longer stay, increased institutionalisation, persistent functional problems
What precipitates delirium?
Infection Dehydration Biochemical disturbance Pain Drugs Constipation/retention Hypoxia Alcohol/drug withdrawal Sleep disturbance Brain injury
How to treat delerium
Treat cause Stop bad drugs Usually no need for drug treatment of delirium Re-orientate and reassure agitated patients Correction of sensory impairment Normalise sleep-wake cycle Ensure continuity of care Avoid catheterisation/venflons
What is dementia
Acquired decline in memory and other cognitive functions in an alert person sufficiently severe to cause function impairment and present for more than 6 months
Alzheimers features
Slow insidious onset
Loss of recent memory first
Progressive functional decline
RFs - age, vascular risk factors, genetics
Vascular dementia features
Step wise progression
Executive dysfunction may predominate
Gait problems
Often known vascular risk factors
Dementia with Lewy Bodies features
Link with parkinson’s
Very fluctuant
Hallucinations common
Falls common
Reversible causes of dementia
Hypothyroidism Intracerebral bleed/tumours B12 deficiency Hypercalcaemia Normal pressure hydrocephalus Depression
Fronto-temporal dementia features
Onset at earlier age
Early symptoms different - behavioural change, language difficulties, memory early on not affected
Lack insight into difficulties
Management of dementia
Support for person and carers Cognitive stimulation Exercise Music/light therapy Cholinesterase inhibitors Antipsychotics - avoid if possible, start low go slow
What is capacity/
Is patient capable of making decisions about their care
Do they have a legally appointed proxy decision maker
Do we/relatives know what their wishes would be
Why do patients fall?
Intrinsic factors - Gait and balance problems, syncope, chronic disease, visual problems, acute illness,
Extrinsic factors - environmental hazards, poor lighting
Situational factors - medications, alcohol, urgency of micturition
Assessment of gait and balance
Sitting to standing ability Transfers Static standing balance Romberg test Dynamic standing balance Gait
Causes of syncope
Situation syncope - acute haemorrhage, cough/sneeze, GI stimulation, micturition, post exercise
Orthostatic hypotension - autonomic failure, volume depletion (haemorrhage, diarrhoea, addison’s)
Cardiac arrhythmias - sinus node dysfunction, AV conduction disease, implanted device malfunction
Structural cardiac or cardiopulmonary disease
Cerebrovacular
Question in a history assessing syncope?
Patient - Prodromal symptoms, loss of consciousness, last and first things they recall, previous episodes, injuries, PMH, FH, medications
Collateral - Circumstances of event, posture before LOC, appearance, movement?, tongue biting, Duration of event, confusion?, weakness?
Examination in assessing syncope?
Vital signs - lying and standing blood pressure
Focussed neurological and cardio exam
Look for injuries
Features of 12 lead ECG in syncope assessment?
Inappropriate, persistant bradycardia, Long QT, Abnormal T wave inversion
