Falls and delirium

Question 1

what are some causes of falls in the elderly?

Answer 1

motor problems - gait or balance impairment, muscle weakness

Sensory impairment - peripheral neuropathy, vestibular dysfunction, vision impairment

Cognitive or mood impairment - dementia, depression, delirium

Orthostatic hypertension

Polypharmacy and meds

environmental hazards

Question 2

Whats drugs are assoicated with falls?

Answer 2

Benzodiazepines 
Antidepressants (TCA's and SSRIs) 
Diuretics 
Anti hypertensives 
skeletal muscle relaxants 
Antipsychotics 
opiates 
Antiarrhythmics 
hypoglycaemics 

(BADAAS)

Question 3

What investigations are useful in investigating falls?

Answer 3

FBC, B12, Glucose, U&E’s, TFTs

Urine dip

X-ray of bones

CT head - ?stroke ?change in mental status, ?bleeding in anticoagulated patients

ECG

Standing and lying BP

Question 4

How can falls be prevented?

Answer 4

Drug review 
OH treatment 
Strength and balance training 
Walking aids 
OT review 
Osteoporosis detection and treatment

Question 5

What is the definition of delirium?

Answer 5

An acute, fluctuating change in mental status with inattention, disorganised thinking and altered levels of consciousness

Question 6

Aside from inattention, disorganised thinking and altered levels of consciousness, what are the other features of delirium?

Answer 6

Sleep wake cycle disturbances
disturbed psychomotor behaviour
emotional disturbance
delusion and poor insight

Question 7

Whats is the classification of delirium?

Answer 7

hyperactive
hypoactive
mixed

Question 8

What are the causes of delirium

Answer 8

PINCH ME

Pain 
Infection 
Nutrition 
Constipation 
Hydration 
Medication 
Environment/endocrine

Question 9

What drugs can cause delirium?

Answer 9

Anticholinergics e.g atropine, hyoscine

Antipsychotics e.g chlorpromazine, thioridazine

Antihistamines e.g chlorphenamine

Benzos and barbituates

Antidepressants

opiates

The A’s and the O’s

Question 10

What screening tools for delirium are available?

Answer 10

4AT - alert, AMT4, attention, Acute change

CAM-ICU

MMSE

Question 11

what investigations are useful in delirium?

Answer 11

FBC, CRP and ESR
- infection and anaemia

U&E’s and creatinine
- electrolyte disturbances, dehydration, renal impairment

Glucose
- hypo or hyper

LFTs and amylase

TFTs

Urinalysis and MSSU

Question 12

how is delirium treated?

Answer 12

Treat the underlying cause

AWI

Reorientation, reassurance, non-verbal communication, deescalation

haloperidol unless parkinsonism

lorezapam (low dose if parkinsons or DLB)