MST Week 4 (falls In Older Adult)

Question 1

Define acute pain

Answer 1

Less than 3 months
Useful protective function while body heals
Medication usually works well

Question 2

Define persistent pain

Answer 2

Continues after 3 months 
Tissues have healed 
Pain is unhelpful 
Caused by over sensitive nervous system 
Medication has limited effectiveness

Question 3

Why do we feel pain

Answer 3

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

Question 4

What are DIMS and SIMS

Answer 4

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)

Question 5

What happens to the brain with age

Answer 5

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

Question 6

What is CBT

Answer 6

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

Question 7

What is acceptance and commitment therapy

Answer 7

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

Question 8

Define fall

Answer 8

An unintentional / unexpected loss of balances resulting in coming to rest on the floor, the ground or an object below knee level

Question 9

What are osteoblasts, osteoclasts and osteocytes

Answer 9

Osteoblasts - make bone
Osteoclasts - break bone
Osteocytes- control balance of breaking and making

Up until about 30, osteoblasts are much more active than osteoclasts

Question 10

Intrinsic risk factors of falls

Answer 10

Vestibular, balance, vit D insufficiency, polypharmacy, orthostatic hypotension, vision impairment, foot or ankle disorder

Question 11

Extrinsic risk factors for falls

Answer 11

Cables, carpets, pavements

Question 12

Behavioural risk factors for falls

Answer 12

Task performance, lifestyle, alcohol / drug misuse

Question 13

What is cartilage

Answer 13

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

Question 14

Describe hyaline cartilage at joints

Answer 14

• 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

Question 15

What is a synovial joint

Answer 15

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

Question 16

What is bursitis

Answer 16

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

Question 17

What is osteoarthritis

Answer 17

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

Question 18

What is pathogenesis

Answer 18

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

Question 19

What is rheumatoid arthritis

Answer 19

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

Question 20

What is gout

Answer 20

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