Thursday, July 12, 2007

Geris tutorial with the Prof

The acute geriatric admission

Principle 1 - Atypical presentation

Geriatric giants:
  • Confusion
  • Falls
  • Incontinence
  • Failure to cope
The reasons that the geriatric syndrome exists and that older people don't present with simple complaints the way younger people would is due to a combination of their underlying medical conditions as well as decreased reserve from multi-system failure and inability to compensate.

Principle 2 - Comorbidity

  • Multiple Dxes and complex issues in Dx and management plan.
  • Drugs and bugs - common precipitants of acute hospitalisation.

Principle 3 - Complications of immobility

Seven sins of immobilisation:
  1. pressure sores
  2. constipation and urosepsis
  3. deconditioning
  4. depression
  5. malnutrition
  6. venous thrombosis
  7. bronchopneumonia

Prinicple 4 - Function

  • Level of function and independence.
  • Discharge planning on admission.

Rules of prescribing

  • Rule of halves (impaired drug clearance, increased adverse effects)
  • Rule of fives (polypharmacy)
  • Medication untrial (adverse drug reactions)
  • Medication trial (careful medical management)


  • Syncope (Stokes Adams, postural hypotension, aortic stenosis, cerebrovascular disease, epilepsy, diabetic hypoglycaemia SPACED)
  • Acute - drugs and bugs etc
  • Chronic - 4 causes: drugs and disorders of eyes, cognition and gait


  • Post void residual for retention (obstruction or neurological disorder)
  • 5 causes: drugs, UTI, atrophic vaginitis, faecal impaction, prostate


  • Acute and fluctuating, inattention, altered LOC
  • Reversible causes (drugs and bugs etc)

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