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.
- Enlist and classify all medicines that you will need.
- State the principles on which you base your choices.
- Enlist 8 psychometric tests/scales you will need?
- Which information do you think you will consider while developing an intake proforma?
Principles Of Prescribing Medications in the Elderly
- 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)
- Avoid drugs that worsen cognitive function, keeping in mind the rates of dementia in this population.
- Keep in mind the risk of fall and over sedation with central depressants and the propensity to side effects.
- Avoid drugs with an alpha-receptor blocking property (hypotension, prostate hypertrophy)
Suitable Choice of Medications in the Elderly
Acetylcholine Esterase Inhibitors
- Donepezil
- Rivastigmine
- Galantamine
NMDA Antagonists
- Memantine
Antipsychotics
- Risperidone
- Quetiapine
- Haloperidol
Antidepressants
- Sertraline
- Citalopram
- Escitalopram
- Mirtazapine
- Trazodone (for agitation and as a hypnotic)
Hypnotics
- Lorazepam
- Temazepam
- Lormetazepam
Mood Stabilizers
- Valproate
- Carbamazepine
- Lithium Carbonate
Psychometric Tools and Rating Scales
Cognitions
- MMSE
- MoCA
- Six-item cognitive scale
- 7-Minute Screen
Behavioural
- Mouse PAD
- Behave AD
Delirium
- CAM
Depression
- Geriatric depression rating scale
- Cornel scale
Activities
- Bristol Scale
- Disability scale for dementia
Global Function
- Clinical dementia rating
Other
- Frontal Assessment Battery
- Hachinski scale
Intake Performa for Old-Age Units
The following are the useful components of the Intake Performa you would need.
- Identification data including a picture for later identification and demographics
- Indication for admission
- Full history from the patient and carers
- Complete physical and neurological and mental state examination
- Functional assessment including cognitive status, motor functioning and mobility, activities of daily living especially self-care, global function, capacity, sensory impairments
- Social assessment
- Accommodation needs,
- Need for a carer
- Needs of carers
- financial and legal issues
- Power of attorney
- Social activities
- Risks: especially Risk of fall, risk of abuse
- Pension/social support
- Next of kin
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