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)

Falls

• 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

Incontinence

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

Delirium

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