Med C CBLs - Falls and delerium Flashcards
Factors that indicate an increased risk of falls
- Previous falls
- Multiple medications (> 4 with sedative and multiple B.P lowering meds)
- Age
- Visual impairment
- OA
- Suggestion of orthostatic hypotension
- Pre-existing functional impairment (walking aids / care)
Important examinations that form part of a falls assessment
- Blood glucose
- Gait assessment
- Lying and standing blood pressure
- Romberg’s test
Orthostatic hypotension defined by
more than 20 drop in systolic
more than 10 drop in diastolic
on standing
What are the elements of management for an acute fall/ injury and to help reduce overall risk?
- Analgesia –> titrate slowly
- Ortho support
- Medication review –> polypharmacy: with hold ACEi, alpha blocker
- Treat underlying infection
- Multi-factorial falls assessment
- gait and balance
- lying and standing BP
- medication review
- call bell - Treat constipation
- Patient education
- Vitamin D, osteoporosis secondary prevention
Possible adverse events of delerium?
- increased risk of mortality
- increased length of hospital stay
- increased risk of needing long-term care
- increased risk of falls
- increased risk of future dementia
4 geriatric giants
- immobility
- incontinence
- impaired cognition
- instability
Who is screened for bone health, osteoporosis and falls
All women aged 65 years and over.
All men aged 75 years and over.
OR
Women 50-64 and men 50-74 if they have
- previous osteoporotic fracture
- recent corticosteroid use
- history of falls
- low BMI
- smoker
- alcohol intake > 14 units
How should you assess a person for fragility fracture for secondary prevention?
1. Exclude non-osteoporotic causes for fragility fracture
- metastatic bone disease
- multiple myeloma
- osteomalacia
- Paget’s disease
2. DEXA scan without calculating FRAX if over 50 with history of fragility fracture
3. If vertebral or hip fractures consider drug treatment WITHOUT DEXA first
4. If risk factors for osteoporosis then –> 10 year fragility fracture risk BEFORE, then DEXA to measure BMD
Causes of secondary osteoporosis
- Endocrine
- premature menopause
- hypogonadism in men
- diabetes mellitus
- hyperthyroidism - Rheum
- RA
- inflammatory arthropathies - GI
- malabsorption due to
—> Crohn’s
—> UC
—> coeliac
—> chronic pancreatitis - Chronic liver disease
- COPD
Cognitive screens to identify non-specific cognitive impairment
10/4 AMT
MMSE
MOCA
6-CIT
Delirium causes
- Drugs
- Electrolyte disturbance (dehydration)
- Low oxygen levels
- Infection
- Reduced sensory input (vision / hearing / environment changes)
- Intracranial (stroke / bleed / cerebral irritation)
- Urinary retention / constipation
- Metabolic causes
- Pain
- Infection
- Nutritional compromise
- Constipation
- Hydration (dehydration / electrolyte disturbance)
- Medication
- Environmental
DELERIUM PINCH ME
