MST Week 4 (falls In Older Adult) Flashcards
Define acute pain
Less than 3 months
Useful protective function while body heals
Medication usually works well
Define persistent pain
Continues after 3 months Tissues have healed Pain is unhelpful Caused by over sensitive nervous system Medication has limited effectiveness
Why do we feel pain
All pain is created by the brain rather than sensory input evoked by an injury
The neuromatrix: pain is produced by a widely distributed neural network in the brain
Pain is always about protection- not about measuring the state of body tissues
Pain and tissue damage are poorly related
What are DIMS and SIMS
DIMs- anything that suggests your tissues need protecting takes pain up (danger in me)
Anything that suggests your tissues are safe takes pain down (safety in me)
What happens to the brain with age
Brain volume decreases
Slower synaptic speed
Loss of synaptic plasticity
Connections between brain regions are less efficient:
- prefrontal cortex affected by ageing and is heavily interconnected with all brain areas
- ageing has widespread effects on cognitive function
What is CBT
Thoughts cause distress and lead to maladaptive behaviour
The aim is to reduce emotional distress and pain by challenging maladaptive thoughts
CBT interventions focus on:
- identifying and changing unhelpful beliefs and appraisals
- decreasing maladaptive behaviours and increasing adaptive behaviours
What is acceptance and commitment therapy
Suffering is normal - destructive normality
The root of suffering is language
Language sets up a struggle with our thoughts and feelings lead to experimental avoidance
Attempts to avoid or escape unwanted experiences have paradoxical effects
Define fall
An unintentional / unexpected loss of balances resulting in coming to rest on the floor, the ground or an object below knee level
What are osteoblasts, osteoclasts and osteocytes
Osteoblasts - make bone
Osteoclasts - break bone
Osteocytes- control balance of breaking and making
Up until about 30, osteoblasts are much more active than osteoclasts
Intrinsic risk factors of falls
Vestibular, balance, vit D insufficiency, polypharmacy, orthostatic hypotension, vision impairment, foot or ankle disorder
Extrinsic risk factors for falls
Cables, carpets, pavements
Behavioural risk factors for falls
Task performance, lifestyle, alcohol / drug misuse
What is cartilage
Specialised connective tissue with a support function (often shock absorbers of the body can be tough or flexible depending on composition of matrix)
Matrix: type II collagen and proteoglycans
Describe hyaline cartilage at joints
- resist compression: elasticity and stiffness of proteoglycans (hydrogel)
- maintained and turned over by chondrocytes
- limited repair and regeneration capacity
- most is a vascular: nutrition is by diffusion (limits thickness)
- articulate surfaces of joints has no perichondrium - no source of new chondroblasts
What is a synovial joint
Freely moveable and quite flexible
Enclosed in a fibrocollagenous capsule lined with specialised secretory cells (synovium), secreting synovial fluid to lubricate the joint.
Fibroelastic ligaments prevent excessive movement
Tendon attachments of skeletal muscles also help to stabilise the joint
What is bursitis
A bursa is a fluid filled sac which provides friction free movement between bones and tendons or muscles around a joint
Lined by synovial cells, secreting synovial fluid
They cause pain when inflamed because they become swollen, causing pressure and reducing friction free properties
Inflammation (bursitis) results from repetitive use, trauma or systemis arthritis
What is osteoarthritis
Most prevalent form of arthritis
Degenerative condition: wear and tear
- loss of articulate cartilage and synovitis due to inflammation
- risk factors are varied: primary, idiopathic
- secondary to trauma, inflammatory disease, joint defects that change distribution of stress at joints
What is pathogenesis
Alteration in composition of cartilage: reduced proteoglycans and collagen; increased water, chondrocyte hypertrophy
Surface cracks and bone is exposed. Becomes burnished from wear
Bone and cartilage fragments in joint cavity
Alteration of mechanical properties, bone shock absorbing properties reduced
What is rheumatoid arthritis
Chronic systemic inflammation involving synovial joints
Evidence for genetic predisposition and immune involvement
- inflammation results from macrophages and neutrophil reaction
Symptoms: fatigue, anorexia, weight loss, joint aching and stiffness, low grade fever, anaemia
What is gout
Crystal artropathy: urate crystals in joints due to hyperuricaemia as a result of underexcretion of Uric acid
Leads to acute inflammation / arthritis at the joint and in the soft tissues
Intermittent but recurrent attacks destroy joint cartilage and soft tissues and lead to OA
