Monday, 25 January 2021

Establishing a Geriatric (old-age) Clinic; Medications and their Principles, Psychometric Tools, and Intake Performa

Establishing a Geriatric (old-age) Clinic; Medications and their Principles, Psychometric Tools, and Intake Performa

Scenario:

In view of increasing needs for elderly population requiring psychiatric help, your medical superintendent asked you to develop a senior citizens' clinic in your hospital. 

  1. Enlist and classify all medicines that you will need. 
  2. State the principles on which you base your choices.
  3. Enlist 8 psychometric tests/scales you will need?
  4. Which information do you think you will consider while developing an intake proforma?

Principles Of Prescribing Medications in the Elderly

  1. Avoid drugs with long-half-lives (increased already in this population because of reduced renal and liver function, increased volume of distribution and relatively higher body fat content)
  2. Avoid drugs that worsen cognitive function, keeping in mind the rates of dementia in this population.
  3. Keep in mind the risk of fall and over sedation with central depressants and the propensity to side effects.
  4. Avoid drugs with an alpha-receptor blocking property (hypotension, prostate hypertrophy)

Suitable Choice of Medications in the Elderly 

Acetylcholine Esterase Inhibitors

  1. Donepezil
  2. Rivastigmine
  3. Galantamine

NMDA Antagonists 

  • Memantine

Antipsychotics

  • Risperidone
  • Quetiapine
  • Haloperidol

Antidepressants

  • Sertraline
  • Citalopram
  • Escitalopram
  • Mirtazapine 
  • Trazodone (for agitation and as a hypnotic)

Hypnotics

  1. Lorazepam
  2. Temazepam
  3. Lormetazepam

Mood Stabilizers

  • Valproate
  • Carbamazepine
  • Lithium Carbonate

Psychometric Tools and Rating Scales

Cognitions

  1. MMSE
  2. MoCA
  3. Six-item cognitive scale
  4. 7-Minute Screen

Behavioural

  1. Mouse PAD
  2. Behave AD

Delirium

  • CAM

Depression

  1. Geriatric depression rating scale
  2. Cornel scale

Activities 

  1. Bristol Scale
  2. Disability scale for dementia

Global Function

  • Clinical dementia rating

Other 

  1. Frontal Assessment Battery
  2. Hachinski scale

Intake Performa for Old-Age Units

The following are the useful components of the Intake Performa you would need. 

  1. Identification data including a picture for later identification and demographics
  2. Indication for admission 
  3. Full history from the patient and carers
  4. Complete physical and neurological and mental state examination
  5. Functional assessment including cognitive status, motor functioning and mobility, activities of daily living especially self-care, global function, capacity, sensory impairments
  6. Social assessment
  7. Accommodation needs, 
  8. Need for a carer 
  9. Needs of carers
  10. financial and legal issues
  11. Power of attorney
  12. Social activities
  13. Risks: especially Risk of fall, risk of abuse
  14. Pension/social support
  15. Next of kin


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