DGM Geriatric Revision

Introduction

Geriatrics is the specialty of 'frailty', managing individuals older than 65-70 years which a lack of physiologic reserve. Geriatric revision should focus on the core pathologies common to our frail communities as well as their wider issues around consent, capacity and ensuring they are safe at home. 

Key Topics

Physiology

• Age related changes to the body, physiologic and pathological

• Age related changes to nervous, endocrine, cardiovascular, respiratory, gastrointestinal, urinary, female and male reproductive, haemotopoetic, musculokeletal and skin systems

Pathology

• Dementia presentations: Alzhiemer's, Lewy Body Dementia, Frontotemporal Dementia, 

• Parkinson's Disease & Parkinson's plus syndromes: Multi-System Atrophy and Progressive Supranuclear Palsy

• Osteoporosis and osteopenia- diagnosis, management and causes

• Frailty- diagnosis and management

• Common pathologies in older age: COPD, CHF, IPF, T2DM, OA, RA, sepsis

Clinical

• Presentation of old age

  • Not coping at home

  • Reduced mobility

  • Falls

  • Dizziness

• Examination

  • Assessing cognition, speech and language

• Common drug side effects related

Wider

• Carer abuse and neglect, Carer stress

• Capacity, consent and confidenditality

• Safety at home: physiotherapy, occupational therapist and social worker

Bite Size Focused Revision

Dementia Differential Presentations

Lewy Body Dementia: Poor memory + visual hallucinations

Fronto-temporal dementia Poor memory + personality change

Vascular Dementia Poor memory + background of vasculopath (diabetes, myocardial infarction, stroke, hypertension, obesity..)

Parkinson's Dementia Bradykinesia, cogwheel rigidity, consipation, postural hypotension THEN poor memory

Alzheimer's Disease Poor memory + gradual decline, absence of above features

Capacity and Consent

Capacity is decision specific. Therefore an individual with dementia may not have capacity to move house but may have capacity to chose their lunch. 

Capacity: Ability to understand, weigh up, retain and communicate information related to decision making

Informed Consent: Can only be given if has capacity and given relevant information related to decision making

Osteoarthritis Analgesia

1. Simple paracetamol 1g QID (500mg QID if under 50kg)

2. Topical NSAIDs

Caution with PO NSAIDs in > 65yrs. Opioids poorly effective for osteoarthritic pain. See WHO pain ladder. 

Bone Health

Osteoporosis: T score > -2.5

Osteopenia: T score -1 to -2.5

T score is derived from a DXA scan. The T score compares the bone mineral density with a healthy individual. A Z score is also often given which compares the bone mineral density with an individual of the same age. 

Resources and References

1. British Geriatric Society: https://www.bgs.org.uk/DGM

2. Royal College of Physicians: https://www.rcp.ac.uk/membership/college-roles/diploma-in-geriatric-medicine-clinical-examination-lead/