In elderly albumin
Decreases
In elderly alpha acid glycoprotein
Increases
In elderly acidic drugs
Work better (due to decreased albumin, as it binds acids)
In elderly basic drugs
Have decreased action
In elderly stomach acid
Decreases
In elderly body water %
Decreases
In elderly the GFR is
Decreased
In elderly the therapeutic window for drugs is
Decreased
A tool to use in elderly for prescribing
STOP START tool
In elderly lipids are
Increased
Lipophilic drugs have an
Increased half life (due to increased lipids)
Infuenza vaccination is given to
- Ages 65 +
- Once per year
Pneumococcal vaccination is given to
- Ages 65+
- As a once off
Shingles vaccination is given to
- At age 70
- As a once off
- “Varicella zoster”
Abdominal Aortic Aneurysm
- Ages 65+
- USS
- 3-4.4cm = annual screening
- 4.5-5.4cm = 3 monthly scan
- >5.4cm = refer for an operation
Colorectal cancer (bowel) screening is for
- Ages 50-75
- Every 2 years
Breast cancer screening is for
- Ages 50-70 (women)
- Every 3 years
Age-related loss of muscle mass and function
Sarcopenia
Muscle mass declines from
Age 30
Muscle mass degradation accelerates at
Age 60
Sarcopenia happens due to
- Decreased sex hormones (oestrogen)
- Increased apoptosis
- Increased mitochondrial dysfunction
3 pharmacological interventions for elderly people
- Creatine/ protein supplements + weight exercise
- ACE Inhibitors (reduce inflammation and increase mitochondrial function)
- Ca2+ and Vit D (for bone strength)
Diagnosis of postural hypotension
- Systolic is <90mmHg
- Systolic has reduced by >20mmHg
- Diastolic has reduced by >10mmHg
Measure after 3 mins of standing up
Management of falls
- Stop medications if underlying cause
- Treat underlying cause
- Strength and balance training (3/7 for 12/52)
- Attend hobbies like Tai Chi
Triad of Delirium
- Disturbance in attention “Disoriented”
- Change in cognition “Disorganised thinking”
- Acute and fluctuating course
Pathophysiology of Delirium
- Derangement of ACh
- Caused due to stress
*
Two types of Delirium
- Hyperactive
- Hypoactive
*
Hyperactive
- Aggitated
- Aggressive
- Wandering
Hypoactive
- Withdrawn
- Apathetic
- Sleepy
Assessments of Delirium
- 4AT
- CAM Assessment
4AT
- Alertness
- Attention: Months of the year backwards
- Acute and fluctuating
- AMT4 (Acute mental test): Age, DoB, Place, Year
What should you always do in delirium
- Reassure
- Re-orientate
- Help patient with sensory aids etc
1st line treatment for Delirium
Haloperidol (Typical antipsychotic)
Haloperidol is contraindicated in
Patients with Parkinson’s Disease and Lewy Body Dementia
2nd line for Delirium
Quetiapine (Atypical antipsychotic)
3rd line for Delirium
(Lorazepam) BZD
1st line for Delirium in Parkinson’s and LBD patients
Quetiapine
1st line for Delirium in Alcohol Withdrawal
Lorazepam (BZD)
If you prescribe Opioids
Prescribe Laxatives alongside this
(due to side effect of constipation from opioids)
If you prescribe Steroids
Prescribe
- Biphosphonates
- Vit D
- Ca2+
Side effects of bisphosphonates
Necrosis of jaw
Side effects of levothyroxine
Hypocalcaemia
If prescribing antiplatelets or SSRIs
Then prescribe PPIs
- Antiplatelets can increase GI bleeds
- SSRIs can increase stomach acid
Do not prescribe Metoclopramide in
Parkinson’s patients
- Metoclopramide is a D2 receptor antagonist
In Heart failure or post-MI prescribe
ACE inhibitors
In elderly patients suffering from Osteoarthritis
Switch NSAIDs for Paracetamol
The truth about statins and the elderly
They take years to actually work… and they area long-term prophylactic- so whats the point?
They interfere with a lot of shit
Not indicated for use > age 75
Palliative care for pain/SOB
Morphine
Palliative care for distressed patients
Midazolam
Palliative care for nausea
Levomepromazine
Palliative care for trouble with respiratory secretions
Buscopan
Morphine (oral) is
10 times the strength of Codeine
(15mg of Codeine = 1.5mg of Morphine)
Morphine (SC) is
twice the strength of Morphine (oral)
(2mg of Morphine (oral) = 1mg Morphine (SC))
Oxycodone is
twice the strength of Morphine (oral)
2mg of Morphine (oral) = 1mg Oxycodone
Oramorph is
of similar strength to Morphine (oral) but is immediate release
Oramorph is used for
- Breakthrough pain
- It is taken PRN
- Is 1/6th the dosage of background dosage
7 steps of a death certificate
- Check for spontaneous movement
- Check for reaction to voice and pain
- Palpate 2 major pulses for 1 min
- Inspect eyes (fixed, dilated, absence of corneal reflex, dry)
- Auscultate heart and lungs for 1 min
- Check for implantable devices
- Record date and time of death
