Geriatric syndromes D. Greyling. Geriatric syndromes 1. Frailty 2. Delirium 3. Falls 4. Sleep...
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Transcript of Geriatric syndromes D. Greyling. Geriatric syndromes 1. Frailty 2. Delirium 3. Falls 4. Sleep...
Geriatric syndromes
D. Greyling
Geriatric syndromes
• 1. Frailty• 2. Delirium• 3. Falls• 4. Sleep disorders• 5.Dizziness• 6. Syncope• 7. Pressure sores• 8. Incontinence• 9. Elder mistreatment• 10.Dementia• 11. Parkinson's
Frailty
• A clinical syndrome of increased vulnerability and decreased ability to maintain homeostasis that is age related and centrally characterized by decline in functional reserves across multiple physiological systems
Frailty
• Suspect if :• 1. Unintentional weight loss of more than 4,5
kg in the past year• 2. Feeling exhausted• 3.Weakness ( Poor grip strength )• 4. Slow walking speed• 5. Low physical activity
Frailty
• Associated with a high risk of falls, dependency disability, institutionalization, hospitalization, risk of iatrogenesis and side effects of medical interventions and death.
• Frailty is part of a single or multiple clinical syndromes
Delirium
• CAM( Confusion Assessment Method):• 1. Acute onset and fluctuating course• 2.Inattention• 3.Disorganized thinking• 4.Altered level of consciousness: From
lethargic, stupor to coma.
Clinical
• History: Precipitating factors• Ask and determine:• 1. Level of consciousness• 2.Orientation• 3.Memory• 4.Attention• 5.Perceptual problems : delusions• 6. Pschycomotor behavior• 7.Sleep –wake cycle
Precipitating factors
• D – Drugs• I – Infections• M- Metabolic ( electolytes,glucose,acid base)
• T- Toxins• O – Oxygen deficiency• P – Psychiatric ( Bereavement, Emotional
stress)
Falls• 35 - 40 % of persons over 65 fall in a given year and increases with
age.
• Risk factors for falls: • 1. Muscle weakness• 2. Gait Deficit• 3.Balance deficit• 4.Use of assistive device• 5.Visual deficit• 6.Impaired Daily Activity of living• 7.Cognitive impairment• 8.Age more than 80
Assessment
• 1. History• 2.Medications• 3.Vision• 4.Gait and Balance : Standing on one leg for 5 sec• Bending • 5.Lower limb joints• 6.Neurological• 7.Cardiovascular: Orthostatic hypotension• Pulse rate and rhythm
Sleep disorders• 50 % of elderly persons complain of sleep difficulty
• 1. Sleep disordered breathing• Hypopneas or apneas during sleep
• 2. Restless legs syndrome : Cluster of repeated leg jerks every 20 – 40 seconds during sleep
• 3. Circadian rhythm sleep disorders: Sleep wake cycle• - sleepy early in the evening and waking up early
• 4. Insomnia : low quantity and or quality of sleep
• 5. Rapid eye movement sleep behavior disorders :• A dissociated state during which complex motoric behaviors occur
Dizziness
• A broad term to describe various abnormal sensations arising from perceptions of the bodies relationship to space and of unsteadiness.
• Older than 65 years 10 % in crease for every 5 years
Causes
• 1. Vestibular causes• 2.Central nervous system causes( TIA / Stroke)• 3.Psychiatric disorders( Depression/ Anxiety)• 4.Cervical spine( Vertebral artery occlusion)• 5.Systemic causes( DM, HT, CAD, Low Hb,
Hypothyroidism,CCF)• 6.Orthostatic hypotension• 7. Post prandial hypotension• 8 Drugs
Syncope
• Rapid onset of transient loss of consciousness and spontaneous complete recovery
• Caused by blunted baroreceptor sensitivity
Evaluation
• Three questions:• 1. ? Loss of consciousness attributable to the
syncope(Trauma, Epilepsy , Vascular, Conversion)
• 2. ? Heart disease• 3. Are there important clinical features that
suggest the etiology ?
Syncope examination
• Orthostatic hypotension• Use of devices for mobilty• Vision• 5 item recall• Gait• Balance• Neuromuscular: Quadriceps strenght• Rigidity,Tremor, Bradikinesai
Pressure ulcers
• Areas of local tissue trauma developing where soft tissue are compressed between bony prominences and any external surface for long periods of time.
• Most common : Sacrum, Ischial tuberosities , throchanters and heels
Stage 1
• Skin intact with redness over a bony prominence
Stage 2 : Loss of the dermis with a shallow ulcer
Stage 3: Full tissue loss
Stage 4: Full thickness with exposed tendon/muscle/bone
Incontinence
• Any involuntary leakage of urine.• “DRIIIPP”• D – Delirium• R- Restricted mobility• I – Infection ( UTI) ,Inflammation ( Atrophic
vaginitis), Impaction of feaces• P- Pharmaceuticals
Types of incontinence
• Stress: Loss of urine with increase of intra – abdominal pressure
• Urge : Inability to delay voiding after sensation of bladder fullness is perceived
• Mixed: Combination of above• Overflow: Due to mechanical forces on an
over distended bladder( Urinary retention/ Abnormal bladder and sphincter function)
Elderly mistreatment
• The willful infliction of pain, injury or causing mental anguish to an elder person.
• Very common – Physical abuse• Neglect• Financial or material abuse• Psychological and verbal abuse• Violation of a trusting
relationship
Risk factors for elderly abuse
• Disability• Cognitive impairment• Abusers likely to abuse alcohol/drugs• Abuser dependency• Living arrangement• External stress• Social isolation• History of violence of the abuser
Dementia
Dementia
• Progressive cognitive and behavioral deficits accompanied by structural abnormalities of the brain.
• DSM IV criteria:• 1. Memory impairment• 2. One of the following disturbances:• - Language disturbance• -Impaired ability to carry out motoric activities• - Failure to identify objects• - Disturbance in executive functioning• 3.Significant impairment in social and occupational functioning• 4.Do not occur during the course of delirium
Mild cognitive impairment
• Memory complaint• Memory impairment for age and education• Preserved general cognitive function• Intact social and occupational function
Parkinson’s Disease
• Any combination of six independent motoric features:
• 1.Rest tremor• 2.Bradykinesia• 3.Rigidity• 4.Loss of postural reflexes• 5.Flexed posture• 6.Freezing phenomenon( Feet glued to the
ground)