WEEK12 FLASHCARDS

why is there a growing need for evidence based elderly care

• ageing population

• increased multimorbidity

• complex treatments

• NHS rationing pressures

what conditions are commonly seen in multimorbidity among the elderly

obesity

t2dm

CVD

evidence base in elderly care

currently limited high quality evidence

key principle when treating older patients

look for evidence

do not make assumptions

what do older people want from healthcare

• remain independent

• manage illnesses

what challenges are faced by elderly patients

poor self care advice

lack of service coordination

inadequate communication between professionals

lack of info on services/ pathways.

how should decisions be made in elderly patients

• individual basis

• consider comorbidities

• impairments

• social context

why is MDT important in elderly care

• holistic , coordinated approach that reflects patients full clinical picture.

what is polypharmacy

prescribing multiple medicines

what is appropriate polypharmacy

when medicine use is optimised and evidence based

what is problematic polypharmacy

inappropriate multiple medicine use without intended benefit

why is monitoring important in polypharmacy

risks like DDIs and ADRs are still present

what is overprescribing

prescribing unnecessary/ harmful medications or failing to prescribe better alternatives

under prescribing

not prescribing needed medication without a valid reason, more likely in polypharmacy

consequences of problematic polypharmacy

falls, frailty, hospitalisation, pill burden, waste , higher workload

tools to address polypharmacy

• STOPP/START

• STOPPfrail

• Medichec

• ThinkCascades

• ACB

• PrescQIPP

What is medichec used for

identifies anticholinergic burden from multiple meds

what does prescQIPP provide

guidance on deprescribing, prioritising medicines and supporting decisions

deprescribing tools

• ACB scales

• opioid deprescribing guides

• medichec

what is ThinkCascades

9 key prescribing cascades likely to be inappropriate in elderly patients

what do anticholinergic medications do

block acetylcholine , affects smooth muscle in lungs, GI, urinary tract

ADRs from anticholinergics

• Dizziness

• dry eyes

• cognitive impairment

• urinary retention

• falls

why are older people at higher risk from anticholinergics

polypharmacy and age related physiological changes

purpose of ACB calculator

quantifies burden, suggests alternatives, supports deprescribing

steps in person centred deprescribing

assess

agree goals

identify inappropriate meds

assess risks/benefits

agree on action

communicate

monitor

what is frailty

gradual loss of physiological reserve, increasing vulnerability

tools for frailty risk assessment

• CFS

• Fried frailty

• FRAIL

• EFS

• rockwood FI

• CGA

• G8

What does g8 screening tool assess

whether a cancer patient over 70 needs comprehensive geriatric assessment

gold standard frailty assessment

CGA- comprehensive geriatric assessment

common bone conditions in elderly

• osteoporosis

• osteomalacia

• Paget’s disease

what is paget’s disease

a chronic disorder that disrupts the normal bone recycling process, leading to enlarged and weakened bones.

why are elderly more prone to fractures

dec bone density

sarcopemia

hormonal changes

reduced osteoblast activity

what is sarcopenia

a condition characterized by the loss of muscle mass and strength due to aging.

what role does IGF-1 play in bone health

• stimulates osteoblast proliferation and differentiation

what hormone prevents bone resorption

oestrogen

who should be assessed for fracture risk

all women >65

men >75

younger adults w risk factors- corticosteroids, falls, family hx

key fracture risk tools

FRAX

QFracture

consequences of falls

• physical injury

• Fof- fear of falling

• functional decline

• hospitalisation

• mortality

fall prevention strategies

exercise

vitamin d/ calcium

safe home environment

vision checks

med review

fall risk assessment tools

TUG

Berg

balance scale

morse scale

osteoporosis - first line treatment

bisphosphonates

alternative treatments for bone loss

• denosumab

• teriparatide

• romosozumab

• HRT

which kinds of cancer treatments worsen bone health

Aromatase Inhibitors

Androgen deprivation therapy

Steroids

bisphosphonates monitoring

review at 5 years

check dor osteonecrosis od the jaw , GI tolerance

why is MDT important in elderly care

• ensures coordinated patient centred care across all domains

what is in the CGA framework

• physical, psychological, functional, social, meds review, personalised care plan.

steps for supportive cancer discussions

acknowledge

normalise

empathise

signpost

refer

monitor

what tool can be used for depression screening in cancer patients

PHQ-9 - can be used in age 12+