Falls Flashcards
When to suspect delirium
Acute behavioral changes
Altered: cognitive function,inattention,disorganized thinking,perception,physical function,social behavior,altered consciousness
CAM
Confusion and innatention
Altered level of consciousness from alertness to lethargy to stupor(difficult to arouse), comatose (unable to arouse),hyper vigilant
Types of delirium
Hyperactive-inappropriate behaviour,hallucinations,agitation
Hypoacrive-lethargy,reduced concentration and appetite
Mixed includes both
Predisposing factors
Age >65
Cognitive impairment
Previous delirium
Poor mobility
Severe current illness eg hip fractures and emergency operations
Visual or heparin problems
Drugs
Social isolation
Triggers
Dehydration
Drugs
Surgery
Substance misuse
Intracerebral insilt eg head injury
Metabolic or electrolyte abnormalities
Deficiency
Endocrine
Urinary retention
Fall cause
Neurological
Chemical
Cardiovascular
Neuromuscular
Environmental
Increased risk of hip fractures
Menopause
Oestrogen
Vitamin D
Calcium
Resorption >formation
What occurs in osteoporosis
Loss of trabeculae
Sarcopenia
Loss of skeletal muscle and mass
Mechanostat theory
Muscle disuse causes osteocytes apoptosis (inactivity/mold activity)
Normal use means osteocytes apoptoses and perturbation are balanced(brisk walking/light work outs)
Too much use means perturbation causing bone to build eg running weight training (osteogenesis loading)
Oestrodiol effects on osteoblasts
Oestrodial stumulates transforming growth factor B (TGF B) on osteoclasts and osteoblasts and inhibits apoptotic affect of IL-6 and T cell production of IL-1 and TNF. If less oestrogen there are more osteoclasts as osteoblasts have shierter survival. RANKL is most powerful stimulant of osteoclasts activity of which it’s action is blocked by denosumab(used to treat people intolerant of bisphosphonates)
