Acute Elderly Care. Ria Daly Clinical Teaching Fellow. Overview. Acute block curriculum Falls Acute confusion Interactive cases. Aims – acute block curriculum. Falls Diagnose the cause of falls in the elderly by history, examination, appropriate use of investigations Acute Confusion
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Clinical Teaching Fellow
Re: Mr A. Notherfall
Thank you for seeing this 82 yr old gentleman who collapsed at home. Has fallen before.
patient you have taken a
<8/10 = Cognitive impairment
Needs further assessment!
Date of Birth
Time (to nearest hour)
Short term memory (“42 West Street”, recall at end)
Recognition of 2 persons (e.g. doctor, nurse)
Name of place they are in
Dates of WW2
Name of present monarch
Count back from 20-1
Transient, self limiting LOC, rapid onset, spontaneous, complete, prompt recovery
Transient impairment of cerebral blood flow
Symptom NOT diagnosis
Assess fluid status
Only if specifically indicated:
12 lead ECG + postural BP (together)
Provides diagnosis in 2/3rd cases
If murmur and clinically suspect relevant
24 hour ECG
Very low yield (<1%)
Specifically best in people with daily symptoms, even then <30%
A 78 year old woman is found by her neighbours confused and wandering in the street at night wearing her night clothes. In the emergency room she appears unkempt and dishevelled.
She is alert, but disoriented in time and place and cannot recall her home address. She engages well with questions, but tends to shift the conversation to stories about her husband and children.
She is admitted to hospital and wanders around the ward appearing lost and, when asked, says that she is looking for a bus stop to go home
How would you assess her?
Obs and MEWS
78 woman is admitted with delirium due to pneumonia. She is pulling at her IV cannula and taking her oxygen mask off.
How would you manage the patient?