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:
- pressure sores
- constipation and urosepsis
- deconditioning
- depression
- malnutrition
- venous thrombosis
- 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)
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