Download Free Medical Geriatric Syndromes PowerPoint Presentation

Geriatric Syndromes PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical PowerPoint presentation titled "Geriatric syndromes” by Shane O’Hanlon & Giuseppe Colloca.

This medical PowerPoint presentation is about Geriatric syndromes, a group of health conditions that are commonly experienced by older adults, and are typically characterized by multifactorial causes and complex interactions among multiple physiological and psychosocial systems.

Some common geriatric syndromes include Falls, Frailty, Cognitive impairment, Delirium, Incontinence, and Malnutrition etc.

Tags : Geriatric syndromes, Falls, Frailty, Cognitive impairment, Delirium, Incontinence, Malnutrition, Geriatrics, Geriatric Medicine, Geriatrics PowerPoint presentation

Published on : May 02, 2023 | Views : 2090 | Downloads : 2

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Shane O’Hanlon & Giuseppe Colloca Geriatric syndromes Treviso, Italy
Slide 2-

Disclosure Nothing to disclose
Slide 3-

Case: Anna is an 84 year old lady with a new diagnosis of breast cancer Past history: hypertension, wrist fracture. Pneumonia & acute confusion 2 months ago didn’t recover to functional/cognitive baseline. Medications: alendronic acid, solifenacin, aspirin atorvastatin, bisoprolol, amlodipine, calcium +Vit D. She lives alone, walks with a zimmer frame, has a carer twice a day. Finds it difficult to climb stairs. Exam: BMI 16. Muscle wasting.
Slide 4-

Geriatric Syndromes Cognitive impairment Malnutrition Mobility impairment & falls Osteoporosis Functional impairment Incontinence Sarcopenia Frailty Polypharmacy
Slide 5-

"a number of symptoms occurring together" συνδρομή, συν δρόμος
Slide 6-

Using the term syndrome is somewhat misleading since this term is normally used to describe a pattern of symptoms and signs that have a single underlying cause. Geriatric syndromes, by contrast, refer to "multifactorial health conditions that occur when the accumulated effects of impairments in multiple systems render an older person vulnerable to situational challenges.”
Slide 7-

The term geriatric syndrome is used to capture clinical conditions that are frequently encountered in older persons, have a deleterious effect on function and quality of life, have multifactorial pathophysiology, often involving systems unrelated to the apparent chief complaint, and are manifested by stereotypical clinical presentations.
Slide 8-

ppt slide no 8 content not found
Slide 9-

Geriatric syndromes reflect the complex interactions between an individual's vulnerabilities and exposure to stressors or challenges.
Slide 10-

Geriatric Syndromes Cognitive impairment Malnutrition Mobility impairment & falls Osteoporosis Functional impairment Incontinence Sarcopenia Frailty Polypharmacy
Slide 11-

Geriatric Syndromes Older adults with cancer have more geriatric syndromes than older adults without cancer Association of Cancer With Geriatric Syndromes in Older Medicare Beneficiaries. Mohile et al (2011) JCO.
Slide 12-

Cognitive impairment Mild Cognitive Impairment Dementia Delirium
Slide 13-

Domains of cognition Memory – long term vs short term Executive function – planning/problem solving Language – object naming, word finding, speech Visuospatial – to acquire and retain visual info Orientation – time, person and place Attention – maintain a response during an activity
Slide 14-

Assessment of cognition
Slide 15-

Mild Cognitive Impairment A slight but noticeable and measurable decline in cognitive abilities, including memory and thinking skills. Not severe enough to interfere with daily function A person with MCI is at an increased risk of developing Alzheimer's or another dementia.
Slide 16-

Memory work-up Thorough history AND collateral history Assessment of function Neuro exam Evaluation of mood Lab tests and brain imaging (CT or MRI) Most of these are to rule out other causes
Slide 17-

Dementia Not one specific disease – a group term for many Decline in memory or other thinking skills At least two of these Severe enough to reduce a person’s ability to perform everyday activities Usually progressive – starts slowly, gets worse Often ignored, or thought part of ageing, by family Patients sometimes not aware
Slide 18-

Alzheimer’s dementia Most common type of dementia (60-80%) Age is greatest risk factor Usually gradual onset and progression Short term memory loss Average prognosis usually 4-8 years after diagnosis, but can be up to 20 years So some people can be very slowly progressive Do not use dementia as a reason for changing treatment without evaluating it!
Slide 19-

PET scans
Slide 20-

Vascular dementia Dementia caused by cerebrovascular disease 2nd most common, about 10% of dementia Can happen suddenly after stroke, or gradually as more blood supply is affected Impaired planning and judgement, word-finding difficulty, memory affected later Behaviour can change: irritable Some seem like they don’t have dementia at all! Link to vascular gait apraxia – lower limb Parkinson’s
Slide 21-

Brain imaging: ischaemic changes
Slide 22-

Signs of late dementia Deepening confusion Not recognising family members Behaviour changes Paranoid suspicions Difficulty speaking, swallowing and walking
Slide 23-

Can you treat it? Some causes of memory loss are treatable Hypothyroidism, depression, thiamine deficiency.. Dementia itself – no cure or treatment Medications that can temporarily improve symptoms Acetylcholinesterase inhibitors (e.g. donepezil) NMDA receptor agonist (e.g. memantine) Also memory rehabilitation
Slide 24-

Why diagnose it? Trial of medication Identification of risk factors that might be modified Support Advance care planning / prognosis
Slide 25-

Modifying risk factors Cardiovascular risk factors: blood pressure, cholesterol, diabetes, smoking, weight Exercise: regular exercise lower the risk Diet: Mediterranean diet Little meat Whole grains, fish, fruit and vegetables, nuts, olive oil
Slide 26-

Decision-making capacity Important to think about this in anyone with cognitive changes of any sort Can they Understand… Analyse… Remember… Communicate the information about the decision Remember it can fluctuate!
Slide 27-

Delirium Sudden onset confusion (or worsening) Fluctuating course Poor attention Most common in people who have some type of cognitive impairment A medical emergency!
Slide 28-

Screening or diagnosis We miss up to 70% of delirium So routine screening recommended, e.g. 4AT Diagnostic tool: CAM
Slide 29-

ppt slide no 29 content not found
Slide 30-

ppt slide no 30 content not found
Slide 31-

Consequences x2-3 times higher mortality Greater functional decline & more likely to need a nursing home More likely to be diagnosed with dementia after an episode (if no previous dementia)
Slide 32-

Delirium and cancer Check for dehydration Check for high calcium Check for infection Are they on steroids? Brain mets are quite rare as a cause of delirium https://academic.oup.com/annonc/article/29/Supplement_4/iv143/5046944
Slide 33-

Other things to check Urinary retention Constipation Opioid toxicity Sedative medications (started or stopped), or other new meds Change in environment? Any previous episodes of delirium (likely to recur)
Slide 34-

Malnutrition Prevalence 2-10% of older population in the community 30-60% of older people in hospital 40-85% nursing home residents 20-70% patients with cancer
Slide 35-

A vicious circle Malnutrition Poor appetite Reduced mobility Reduced feeding capacity Apathy, depression, poor concentration Loss of muscle strength
Slide 36-

Causes “Meals on wheels” Medications Emotional (depression) Alcoholism, abuse Late life paranoia Swallowing problems Oral problems Nosocomial infections Wandering/dementia Hyperthyroidism, hypercalcemia, hypoadrenalism Enteric problems (malabsoption) Eating problems (e.g. tremor) Low salt, low cholesterol diet Shopping and meal preparation problems
Slide 37-

Consequences of malnutrition for older people with cancer Loss of weight and muscle Reduced immune competence, more infections Psychosocial stress Lower quality of life Treatment toxicity Greater mortality
Slide 38-

ESPEN Guidelines Screen each patient's nutritional status early in the course of his or her cancer treatment. Identify signs or symptoms of anorexia, cachexia, and sarcopenia as early as possible. Measure muscle mass precisely by sensitive imaging technologies (e.g. CT) for early detection of malnutrition/sarcopenia. Use specific biomarkers to assess severity of cancer related systemic inflammation, e.g. CRP and albumin. Use indirect calorimetry to estimate resting energy expenditure (REE) in order to personalize energy and protein needs. Use nutrition and metabolic support as a vital part of cancer care Assess physical function routinely to monitor and guide physical rehabilitation. https://www.espen.org/files/ESPEN-Guidelines/PIIS0261561417302285.pdf
Slide 39-

Mobility impairment and falls
Slide 40-

Mobility impairment Loss of symmetry of movement (PD, pain, stroke) Difficulty initiating or maintaining gait (PD or vascular gait apraxia) Retropulsion (PD) Foot-drop (peripheral neuropathy, trauma) Short step length (fear of falling, arthritis, PD, vascular gait apraxia) Broad based gait (cerebellar problems, alcohol, bilateral kne or hip problems) Stops walking when talking (cognitive) Poor safety awareness (cognitive)
Slide 41-

Gait speed J Geriatr Phys Ther. 2003;26(3):14-22. 0.82 m/s BMJ2011;343:d7679
Slide 42-

Falls Yearly, 1 in 3 adults over 65 years falls In nursing homes, 1 in 2 In 40% to 60% of older people, a fall results in physical damage, of which 10-15% serious damage
Slide 43-

Medical risk factors Impaired musculoskeletal function, osteoporosis, gait abnormality Cardiac arrythmias, blood pressure fluctuation Depression, dementia Arthritis, hip weakness and imbalance Neurologic disorders Vision or hearing loss Side effect of medications
Slide 44-

Other risk factors Lack of activity Intoxication Dehydration Malnutrition Shoes and walking aids Risk factors at home
Slide 45-

How to assess falls History gives diagnosis in most cases Was there a prodrome (dizziness, chest pain)? Did you lose consciousness? Were there any injuries? Can you get up by yourself? Have you fallen before?
Slide 46-

Common causes in older people Orthostatic hypotension (too many blood pressure meds? Dehydration? Recent illness? Parkinson’s?) Also check for aortic stenosis Osteoarthritis – stiffness, pain in joints affecting mobility Medications – almost every one increases risk! Cognition – poor safety awareness Less common: arrhythmia, seizure, Parkinson’s, stroke
Slide 47-

How to reduce falls Multicomponent intervention Otago exercise programme (reduces risk of falls & fall-related injuries and death, improves QOL – but not bone mineral density)
Slide 48-

Osteoporosis A systemic disorder of the skeleton characterised by a loss of bone strength and increased risk of fractures
Slide 49-

Epidemiology Worldwide: 200 million people European Union: 22 million women and 5.5 million men United States: 8 million women and 2 million men Effect: 1:3 women and 1:5 over the age of 50 years will have one or more osteoporotic fractures in their lifetime
Slide 50-

Osteoporosis risk
Slide 51-

Diagnosis of osteoporosis DEXA scan But if fragility fracture in older adult, treat as osteoporosis Can also use FRAX score as a risk assessment tool – gives estimated risk of osteoporosis related fracture in the next 10 years
Slide 52-

Causes of osteoporosis Decreased mechanical stress Weight loss Catabolic state Chronic inflammation Medication
Slide 53-

Cancer related causes Steroid therapy Aromatase inhibitors Androgen deprivation therapy Chemotherapy – impact on ovaries Oophorectomy Primary bone cancer or mets increase fracture risk
Slide 54-

Sequelae of a hip fracture 25-33% mortality after 1 year In those >75 years: 50% mortality 25% permanent immobility Only 14-21% full recover of ADL capacity
Slide 55-

Vertebral fractures Finding vertebral fractures is a chance to prevent a future hip fracture Treatment (e.g. bisphosphonates or denosumab) is very good at lowering risk
Slide 56-

Functional impairments Limitations in IADL 40% Limitations in ADL 28% Impaired mobility 34%
Slide 57-

Functional impairment + cancer Very little research Huge variation across cancer types, whether treated, whether during treatment or after Many treatments will affect function, and it may be a reason to stop treatment Functional impairment may be worse than shorter survival with good QOL
Slide 58-

Ageing and disability
Slide 59-

Incontinence Prevalence in women 20-39 years 7% 40-59 years 17% 60-79 years 23% ≥80 years 32% Nursing homes 60-80% Prevalence in men: approximately 1/3 in early years, equal over 80 years
Slide 60-

Aetiology Changes in the lower urinary tract and innervation Patient level Comorbidities Medication: diuretics, antihypertensives Functional and mobility impairments NOBODY ever asks patients about this! But it has a huge impact on QoL
Slide 61-

Management Find out the cause: stress vs urge Reduce caffeine, regular toileting Ensure no constipation Medications: anticholinergics (but can cause confusion, dry mouth, constipation…) Incontinence-wear if necessary Sometimes a catheter Surgery
Slide 62-

Consequences Impact on self-esteem Social withdrawal Falls risk Caregiver burden
Slide 63-

Care giver burden 44% care givers for older cancer patients say that the burden of care is too great In many cases, the caregiver is required to make oncologic treatment feasible!
Slide 64-

Musculoskeletal Aging, Sarcopenia
Slide 65-

Body composition Demling RH. Eplasty. 2009 Fat Mass Lean Body Mass (LBM) – Muscle – Visceral tissue – Connective tissue – Other 5% 60% 20% 15% 25% 75% % Body composition(by weight) Protein 20% Minerals 10% Water 70% Muscle is a major component of LBM and plays a vital role in maintaining health1 Strength Energy Mobility Skeletal support and balance Wound healing Immune function Digestive function Skin health
Slide 66-

1. Grimby G, Saltin B. Clin Physiol. 1983;3:209–218. 2. Flakoll P, et al. Nutrition. 2004;20:445–451.3. Baier S, et al. JPEN J Parenter Enteral Nutr. 2009;33:71–82. 4. Janssen I, et al. J Appl Physiol. 2000;89:81–88. Loss of muscle mass and strength, a natural part of aging After age 40, healthy adults can lose 8% of muscle every 10 years Between 40 to 70 years old, healthy adults lose an average of 24% of muscle % peak muscle mass Loss each decade after age 70 15% 24% loss from age 40–70 100 90 80 70 60 50 25 30 40 50 60 70
Slide 67-

Aging and muscle Consequences of losing LBM/Muscle Demling RH. Eplasty. 2009;9:65–94
Slide 68-

Goodpaster BH, et al. J Gerontol A Biol Sci Med Sci. 2006;61:1059-1064. Older men and women lost strength over time; men lost almost twice as much strength as women Men Women Lean Mass Strength Strength Lean Mass P <.001 P <.301 P <.001 P <.016 Changes from baseline (%) -2 -6 -10 -14 -12 -8 -4 0 Declines in leg lean mass and muscle strength over 3 years Health ABC Study: muscle strength declines more than muscle mass Weight loser (< 3%) Stable weight Weight gainer (> 3%) 2 -16
Slide 69-

Stable body weight masks age-related changes in body composition Gallagher D, et al. Am J Physiol Endocrinol Metab. 2000;279:E366-375. The 0.5 kg decrease in body weight resulted mainly from a combined • decrease in fat-free body mass (– 1.4 kg) and increase in fat mass (+ 1.2 kg) ∆ Kilograms Weight Fat Mass Fat-Free Skeletal Total Appendicular Mass Leg Skeletal Mass Arm Skeletal Mass Bone Mineral ↓ ↑↑ ↓↓ ↓ ↓ ↓  -2.0 0 0.5 1.0 1.5 -1.5 -1.0 -0.5 2.0 Changes in body composition after age 60 in healthy older men: longitudinal study with follow-up time 4.7 ± 2.3 years
Slide 70-

Health ABC Study: inter- and intra-muscular fat increase even with stable body weight Delmonico MJ, et al. Am J Clin Nutr. 2009;90:1579-1585. Thigh cross-section view (magnetic resonance) Thigh cross-section view (computed tomography)
Slide 71-

Sarcopenia AGING “Sarcopenia is a (geriatric) syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength (and/or function) with a risk of adverse outcomes such as physical disability, poor quality of life and death”
Slide 72-

European consensus definition of sarcopenia(EWGSOP*) *European Working Group on Sarcopenia in Older Persons Age Ageing. 2010;39:412-423. A syndrome characterized by progressive and generalized loss of skeletal muscle mass and function with a risk of adverse outcomes, such as physical disability, poor quality of life, and death Criteria for the diagnosis of sarcopenia 1. LOW MUSCLE MASS 3. LOW PHYSICAL PERFORMANCE 2. LOW MUSCLE STRENGTH OR SARCOPENIA
Slide 73-

Sarcopenia increases likelihood of poor physical function and increased disability Janssen I, et al. J Am Geriatr Soc. 2002;50:889-896. Likelihood of not being able to:
Slide 74-

Primary versus secondary sarcopenia Curr Opin Clin Nutr Metab Care. 2010;13:1-7. *European Working Group on Sarcopenia in Older Persons definition
Slide 75-

The etiology of sarcopenia Thomas DR. Clin Nutr. 2007;26:389-399. Ryall JG, et al. Biogerontology. 2008;9:213-228. Cruz-Jentoft AJ, et al. Curr Opin Clin Nutr Metab Care. 2010;13:1-7. (Growth hormone/IGF-1, testosterone, DHEA, estrogens)
Slide 76-

Association between sarcopenia and all-cause mortality during hospitalization and after one year No Sarcopenia p=0.004 p=0.003 770 in-hospital patients Sarcopenia and mortality in hospital J Gerontology, 2014
Slide 77-

Comparing sarcopenia and cachexia Thomas DR. Clin Nutr. 2007;26:389-399. Morley JE, et al. Nutrition. 2008;24:815-819.
Slide 78-

Sarcopenia and frailty overlap Fried LP, et al. J Gerontol A Biol Sci Med Sci. 2001;56:M146-156. Cruz-Jentoft AJ, et al. Age Ageing. 2010;39:412-423. Bauer JM, et al. Exp Gerontol. 2008;43:674-678.
Slide 79-

Tools for measuring sarcopenia parameters Cruz-Jentoft AJ, et al. Age Ageing. 2010;39:412-423. www.grc.nia.nih.gov/branches/leps/sppb/
Slide 80-

Image – based muscle quantification on axial CT images 3rd lumbar vertebra Shen W et al J Appl Physiol 2004, 97:2333-8
Slide 81-

SARCOPENIA CUTOFF VALUES BASED ON CT SCAN ASSESSMENT MUSCLE MASS AT THE LEVEL OF L3 Skeletal Muscle Index (SMI) at the level of L3 Males: <55 cm2/m2 Females: <39 cm2/m2 Prado C. Lancet Oncol 2008; 9: 629–35 Clinical Nutrition . 2014; 33: 737-748
Slide 82-

Chemotherapy is reduced >20% or terminated in sarcopenic patients, due to excess toxicity Dose-limiting toxicity, % Clin Cancer Res. 2009 15:2920-6; Clin Cancer Res 2007;13:3264-8; Ann Oncol. 2010; 21:1594-8; Br J Cancer. 2013; 108:1034-41; PLoS One. 2012;7(5):e37563; Clin Endocrinol Metab. 2013;98:2401-8, Inv New Drugs, 2013; PLoS One. 2012;7(1):e29330
Slide 83-

Take home message Many geriatric syndromes interact and amplify each other Geriatric syndromes and functional impairments are highly prevalent and easily missed if not specifically looked for The presence of geriatric syndromes reflects a patient’s fitness/vulnerability which has significant consequences for oncologic treatment