Delirium, immobility and falls Flashcards
(22 cards)
What are the 4 main features of delirium?
Disturbed consciousness
Change on cognition
Acute onset
Fluctuant
What changes in cognition may be present in delirium?
Memory Perceptual Language Illusions Hallucinations
Can delirium affect physical function?
Yes
Can cause disturbed pscyhomotor behaviour
What is the difference between delirium and dementia?
Delirium is typically caused by acute illness or drug toxicity (sometimes life threatening) and is often reversible
Dementia is typically caused by anatomic changes in the brain, has slower onset, and is generally irreversible
What are some factors which may precipitate delirium?
Infection Dehydration Pain Drug toxicity/withdrawal Hypoxia Urinary retention Sleep disturbance Brain injury Stress
What are some consequences of delirium?
Increased morbidity and mortality
Longer stay
Increased institutionalisation
Persistent functional decline
How is delirium diagnosed?
History
Exam
TIME bundle
4AT (screening)
What are some non-pharmacological treatments for delirium?
Encourage early mobility and self care Correct sensory impairment Normalise sleep cycle Ensure continuity of care Avoid hospital Avoid catheterisation
How does delirium affect future health?
More likely to develop dementia
Risk of further episodes delirium/frailty
How does delirium affect falls?
4.5x more likely to fall
Delirium interventions also reduce falls
What is the TIME bundle?
Triggers (exclude/treat)
Investigate/intervene
Management
Engage and explain diagnosis
What are some kinds of drugs which may cause falls?
Antihypertensive Beta blocker Sedatives Anticholinergics Opioids Alcohol
What are some roles of a doctor in a falls clinic?
Full exam
Bone health
Osteoporosis
How would peripheral neuropathy affect gait?
High stepping
How would stroke affect gait?
Hemiplegic
How would vascular parkinsonism affect gait?
Small shuffling steps
How would cerebellar damage affect gait?
Ataxic
How would arthritis affect gait?
Arthralgia
Name some injuries immediately checked for in the event of a fall in hospital?
Head injury and extra dural Seizure C spine Flail chest Abdominal injury Pelvic Limb fracture
When should you get a CT scan after a fall?
GCS <13 Confusion after 2 hours Focal neurology Skull fracture Seizure Vomiting Anti-coagulation
What are some possible causes of falls in inpatients?
New medication Low blood glc Getting sicker Delirium Call bell out of reach Inappropriate footwear
How may bisoprolol lead to falls?
Postural hypotension
Bradycardia
