what are the barriers to adherence?
- medication- specific barrier
(too much med, different timings, difficult to remember) - illness-specific barrier
(cognitive decline, peripheral neuropathy) - patient- specific barrier
(personal taste/ disgust) - logistical and financial barrier (too expensive)
proposed mechanisms for depression
- monoamine hypothesis: decreased neurotransmitter concentrations e.g. serotonin, norepinephrine, dopamine
- cytokine g. IL-1B
- Neuropeptides e.g. substance P and corticotropin releasing factor
causes of delirium
Drugs
Eye/ears
Low o2 states due to AMI, stroke, GI bleed
Infection
Retention of urine/faeces
Ictal
Under hydration
Undernutrition
Metabolic
Subdural
causes of dementia
Reversible
Drugs (anticholinergics, H2 blockers, Benzodiazepines)
Emotions (depression)
Metabolic (hypothyroidism, hypercalcemia)
Eyes/ears (sensory isolation)
Normal pressure hydrocephalus
Tumour/space occupying lesions
Infection (syphilis, HIV)
Anaemia (vit. B12 deficiency)/ alcoholism
irreversible
- Degenerative brain disease e.g. Alzheimer’s disease, Parkinson’s disease, Lewy body dementia, progressive supranuclear palsy, frontotemporal dementia, genetic
vascular dementia
prion diseases
Risk factors of dementia
female
gender
genetic factors
down’s syndrome
family history
early AD gene mutation rare but deterministic: amyloid, precursor protein, Presenilin-1, Presenilin-2
late onset AD gene mutatio. are common and risk conferring: APOE gene (19)
Immobility results in?
MSK: contractures, decreased strengths, pressure ulcers, bone loss, increased fracture risk
Resp: pneumonia, decreased ventilation
CVS: DVT, postural hypotension, decreased work capacity
CNS: deterioration in balance and coordination
Genitourinary: urinary incontinence, incomplete bladder emptying
GI: decrease appetite, constipation
predisposing factors to adverse drug effects
- polypharmacy due to co-morbidities
- decline in liver function
- decline in renal function
- cognitive impairment (under/overconsume medications)
- Poor eyesight (under/overconsome med)
- physical limitations : might not be able to pack pills properly, not able to break pills into halves
drug classes that increases fall risk
- benzodiazepines and anti-psychotics - cause sedation, dizziness, altered gaits and balances, impaired cognition
- any hypertensives (ABCD) - postural hypotension
- insulin and oral hypoglycemic agents - hypoglycemia
causes of acute functional decline
- worsening of known conditions/ illness
- new illness e.g. stroke, infections, falls, delirium
- initiation of new medications
- electrolyte disturbances
- dehydration
- hypoglycemia
- poor med compliance
- underlying dementia
strategies to prevent functional decline
mindful of likelihood
identify and assess general body system specific high risk indicators
implement preventive management strategies targeting one or more relevant domains
managing cognition, emotional health, self-care, continence, nutrition and skin-integrity
