Gerries

Advice from Rheumatology at Hope
If low serum vit d (D3) commence Adcal-D3 2 tabs od and recheck 3m
If still low consider -one off ergocalciferol 300 000 u IM or 20 000 u bd po for 5 days
be sure to check full bone profile PTH and coeliac serology

OA in the elderly

NICE CG59 OA Feb 2008

Osteoporosis elderly

hacking-medschool/osteoporosis

Assessment pain in older people

Royal College of Physicians, British Geriatrics Society and British Pain Society

http://www.bgs.org.uk/Publications/Clinical%20Guidelines/clinical_guidelines_index.htm

Hearing problems elderly

Hearing Problems AAFP

Communicating With Impaired Elderly Elderly Care Online

Visual problems lderly

Vision Problems in Aging Adults Cleveland Clinic

Common Causes of Vision Loss in Elderly Patients AAFP 1999

Constipation in the elderly

Constipation in the Elderly AAFP

Constipation in Elderly Medscape

ahealthstudy.com/ constipation elderly

Continence in the elderly

Urinary incontinence SIGN Guideline 79

Urinary Incontinence in the Elderly Medscape

Diagnostic Evaluation of Urinary Incontinence in Geriatric Patients

allaboutincontinence.co.uk/elderly

Mobility & falls

NICE CG21 Falls Nov 2004

NHS Information Centre June 2011

BMJ Postural Hypotension Jun 11

Fall assessment in older people BMJ Sep 2011

Nice Risk Assessment

RCP Fallsafe

Stay on your feet Western au

Leg ulcers

youtu.be/nYt12EK_cFY

youtu.be/5Xua6CC0GxQ

Pressure sores elderly

hacking-medschool/pressure-area-care

Pressure Ulcers Medscape

elderlycaretips.info Pressure Sores

rcn.org.uk pressure ulcer guidelines

howtocare.com/pressure sores

Influenza / flu vaccination in the elderly

250textbooks/influenza-vaccination

Pensions and benefits for older people

Pensions including State Pension

Pension Credits

Winter Fuel Payments

Housing Benefit

dwp.gov.uk housing benefit

Carers Allowance Direct.gov

Attendance Allowance Direct.gov

www.pensions.gov.uk

thepensionservice.gov.uk

CAB

direct.gov.uk Benefits/Concessions and other help

Annuities
(EFIGM Bracewell Gray & Rai)
see also Benefits section

Driving regs elderly

DVLA Medical Advice AAG

A-Z guide for patients

GP must
inform the patient that he/she must contact the DVLA and his/her insurance company
complete the medical report requested by the DVLA, if there is consent
consider whether a patient is fit to drive while awaiting assessment
inform the DVLA if we consider there is a danger to the patient or others

Driving and dementia BMJ 2007 Risk is low in the first three years following onset of dementia

Cold weather

Cold Weather Plan 2011

Hypothermia in the elderly

AAFP 2004

http://www.orthogate.org/cases/trauma/hypothermia-causing-multi-system-complications-in-elderly-patient-with-femur-neck-fracture.html

Mental health elderly

NICE PH16 Mental wellbeing and older people Oct 2008

QRG

Depression & anxiety in the elderly

No evidence for efficacy of antiDs in elderly with dementia EEP Infopoems Jun 2011

Newer antidepressants less safe in the elderly BMJ Aug 2011

Depression in older adults BMJ Jul 2011

Alcohol in elderley

BMJ 2003 Alcohol Abuse Elderly

ias.org.uk/factsheet

icap.org Alcohol and the Elderly

Alzheimers dementia confusion memory loss

hacking-medschool/memory-loss

CKS dementia

dh.gov.uk spotting the signs of dementia

alzheimers.org.au

Suspected early dementia Rational Imaging BMJ Sep 2011

Cognitive assessment of older people BMJ Sep 2011

mediacentre.dh.gov.uk dementia campaign

QOF Targets Dementia

Annual Review
BP, BMI, smoking status/cessation, assessment of falls & injuries, safety at home (Careline, alarms, Home-care), consider OT, physio, falls/balance assessment. Review repeat medication and co-morbidities.
Annual bloods depend upon co-morbidities rather than dementia.

Management
Primary Prevention
ACE, statins or aspirin are not recommended for the primary prevention of dementia but control HT, DM, CVD risks according to NICE/Practice guidelines.

Secondary Prevention:
Treat CVD risks according to guidelines.
At the time of diagnosis and annually afterwards, assess medical and psychiatric co-morbidities, including depression and psychosis.

Medication
Acetylcholinesterase Inhibitors are prescribed by secondary care. They are licensed for those with Alzheimer’s disease of moderate severity (10-20 points on MMSE) or with scores >20 with moderate dementia judged by deterioration in social/functional ability. The patient will have at least 6 monthly reviews for functional and behavioural assessment, and are continued if there is evidence of benefit from clinician, patient or carer.
They are sometimes prescribed for Lewy body dementia with severe challenging behaviour where other methods are ineffective.

Antipsychotics/ benzodiazepines
These should be prescribed at the lowest dose for the shortest time, with close monitoring for effects. Remember the increased risk of cerebrovascular events with antipsychotic medication in mild behavioural problems with Alzheimer’s, vascular or mixed dementia. Those with Lewy body dementia can have severe adverse events. Antidepressants for those with dementia should be started by specialists.

Social Interventions
Carer support and assessment(Carer’s Connection Bradford, Alzheimer’s society, Making Space)
Community careHome care, day care, respite care.
Financial DLA (under 65), Attendance Allowance, Carer’s Allowance. Refer to below website CAB/DWP.
Lasting Power of Attorney property, affairs and personal welfare. Includes healthcare and treatment decisions.
Advanced decisions legally binding, can make treatment decisions about their future.
Making a will Alzheimer’s society can give details of solicitors with experience in dementia.
Driving DVLA & Insurance company must be informed. Their licence may be revoked/ limited, or need regular review.

Referral
Suspected Mild Cognitive impairment patients can be referred to memory clinic for assessment. Early diagnosis is emphasised by NICE in order to access resources for patient/carers, planning and medication.
Consider referral for:
Confirmation of diagnosis of dementia
Suitability for medication
Problematic behavioural/psychological symptoms
Risk assessment
Support for patient/carer

alzheimers.org.uk

ace.org.uk

Mental Illness In Primary Care Mark Morris 2009 Radclife
Questions for Patient and relative/carer
Have you noticed any change in personality?
Have you noticed any increased forgetfulness?
Have any activities been give up? why?
Has there been any problems recognising people?
Have there been any difficulties with speech?
Have the changes been gradual or has there been sudden worsening?

www.nice.org.uk/nicemedia/pdf/CG042NICEGuideline.pdf

Pharmacological: three cholinesterase inhibitors – mild to moderate Alzheimer’s disease: donezipil, rivastigmine and galantamine.

P Physical problems, like pain, may trigger behavioural change.
A Activities of others are annoying or frightening to the patient.
I Intrinsic features of dementia are appearing, like wandering.
D Depression underlies the behaviour change, or there are delusions/psychtotic symptoms