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- Withdrawn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
