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Geriatrics
Disorders of the locomotion
Courses of Geriatrics
 


 

Faintnesses and falls:

A - DEFINITION:

Important place in the causes of loss of autonomy and dependence.

The fall is the consequence of any event which makes fall the subject to ground against its will.

Especially not to standardize it.

Faintness is an acute episode characterized by a disorder of the conscience or vigilance, with or without hypotonia, which can be responsible for fall.

Term used in a very broad and often unsuitable way.

It is an acute pathological situation perceived by the patient or the entourage like a modification of his former state.

B - EPIDEMIOLOGY:

1) INCIDENCE:

30% of more than 65 years.

50% of the institutionalized patients

80% of more than 85 years.

2) SOCIO-ECONOMIC CONSEQUENCES:

30% of the reasons for hospitalization of the old people.

1/3 of these patients are likely to be placed in institution in the 6 months who follow.

C - The INTERROGATION:

It is fundamental.

1) TO SPECIFY the SCHEDULE:

• What time

• Moment: to raise, sleep

• Distance from the nearest meal

2) TO SPECIFY THE CIRCUMSTANCES:

What made the patient at the time of the accident

a) Fall mechanical:

• To inspect the buildings of dwelling

• To give councils for the provision of the objects

• To check the height of the seats and the bed

• Natural of the floor covering

b) Nonmechanical falls:

• With the rising

• With the effort

• With the rotation of the head

3) TO SPECIFY THE FUNCTIONAL SIGNS:

has) Loss of consciousness:

• Cause or effect

• Methods of loss of consciousness

b) With carries part:

Brutal or progressive loss.

c) thoracic Pain:

• Dyspnea

d) Palpitations:

e) Giddinesses, visual blur, cephalgias

f) Hunger, sweat:

Metabolic disorders.

g) Driving or sensitive deficit transitory:

Sign of a transitory ischaemic cerebral accident vascular.

4) TO SPECIFY THE LOSS OF CONSCIOUSNESS:

a) Partial or complete:

To make specify by the patient if it heard what occurred around him.

The patient can hear but not see.

Possibly sign of an episode epileptic.

b) Duration:

Very important to measure the risks of possible after-effects.

c) Before or after the fall:

Important to know which of the two factors involved the other.

d) Pulsations:

Possibly taken by a member of the front entourage, during or after the loss of consciousness.

Can draw attention to a disorder of the rate/rhythm.

e) Demonstrations before and afterwards:

• Rotation of the eyes

• Bite of the language…

f) Methods of return to the conscience:

D - SUPPORTING FACTORS:

1) INTRINSIC FACTORS:

a) Dependent on a pathology:

• Orthostatic arterial Hypotension

• Neurological Disorders: epilepsy, AVC, giddinesses, cérébelleux syndromes

• Disorders of the rate of heartbeat

• Conductive Disorders: syncopate (often an associated traumatism)

• Cardiovascular Accident

• Tiredness

• Denutrition

b) Dependent on ageing:

• Disorders of hearing

• Disorders of balance

• Reduction in the muscular force

• Podologic Attacks: badly adapted shoes

2) EXTRINSIC FACTORS:

a) Bad ergonomics of the framework of life:

b) Psychosocial environment:

• Home environment either absent, or stressing

c) Bad medicamentous catch:

• Accumulation

• Interactions

E - CONSEQUENCES OF THE FALLS AND FAINTNESSES:

They are generally serious and often involve a syndrome of slip.

1) TRAUMATISMS:

has) Fractures:

• 30% of fractures of the collar

• Front armlever

• Wrist

• Ankle

• Spinal Column

b) Wounds and hématomes:

2) COMPLICATIONS OF DECUBITUS:

a) Circulatory:

• Phlebites

• Pulmonary Embolisms

b) Escarres:

c) pulmonary Obstruction:

• Involving pulmonary infections

d) Amyotrophies:

e) Urinary disorders:

• Infections

• Incontinence

f) Complications of the anticoagulants treatments:

• Haemorrhages

• Cerebral Haemorrhage

g) Psychological complications:

• Fear of falling

• Involves a stiffness which supports new falls

• Modification of the body diagram

• Social and psychological Consequences: grabaterisation

F - PARTICULAR ROLE OF THE IDE:

1) The RECEPTION:

The first hour is determining.

It is the moment privileged to note the signs which will make it possible to direct the diagnosis.

The first interventions are often determining for the evolution of the state of the patient.

2) THE COLLECTION OF INFORMATION:

Disorders of walk:

A - NONNEUROLOGICAL AFFECTIONS:

1) AFFECTED RHUMATOLOGIQUES:

a) Coxarthrose:

Especially if it is bilateral.

Amplitude of decreased walk.

b) After-effects of traumatisms:

• Cal

• Badly consolidated Fracture

c) Deformation of the foot:

2) VASCULAR AFFECTIONS:

has) Arteritis

Pain in the calf beyond of a certain perimeter of walk.

Generally people who have the night badly.

B - NEUROLOGIC AFFECTIONS:

1) PROPRIOCEPTIVE DISORDERS:

a) Cervicarthrosic Myélopathies:

b) Sclerose combined:

2) DISORDERS CEREBELLEUX:

Ebrious walk.

Widening of the quadrilateral of lift.

a) Degenerative diseases:

b) Tumours of the posterior pit:

c) AVC:

3) VESTIBULAR DISORDERS:

Paroxystic giddiness positional benign

Can be solved with the urgencies by a simple operation.

 4) PYRAMIDAL DISORDERS:

a) Painless intermittent limping

b) Cervicarthrosic Myelopathy

c) pseudo-bulbar Syndrome

5) DISORDERS EXTRAPYRAMIDAUX:

a) Parkinson's disease

b) MSA

6) DISORDERS OF THE POSTURE

a) Hydrocéphalie with normal pressure

b) Pseudo-bulbar syndrome

c) Phobia of walk

7) ASSOCIATION OF PATHOLOGIES:

8) DRUGS:

• Benzodiazepines

• Nerve sedatives

9) HEMATOME SOUS-DURAL:

Epilepsy of the old subject:

A - DIAGNOSIS:

Very difficult to diagnose.

Possibly several territories epileptogenes.

Generalized or partial crises.

Difficult to distinguish from the other symptoms due to the age: incontinence.

Attention to distinguish:

• Cardiac Syncope

• Malayan vagal

Electroencephalogram

• Points or points waves

• Organic Hearth: waves theta or delta

Scanner without and with injection

B - SEEK CAUSE:

a) Tumour

• Méningiome

• Metastases

b) Alcohol

Weaning of alcohol itself or benzodiazepines

c) After-effects of AVC

d) Metabolic

To take the glycemia immediately

e) Disease of Alzheimer

f) Without cause

g) Hématome under-dural

Emergency measures:

• To make a capillary glycemia

• To take the temperature

• To take the tension

• Checking of the pulse

• To seek a possible wound

• To seek the signs of pain

Ostéo-articular pathologies:

A - POLYARTHRITIS RHUMATOÏDE:

1) ETIOLOGY:

Unknown factor

Incidence for 100.000 inhabitants:

• 19,8 between 50 and 59 years

• 112,2 between 70 and 79 years

2) PRIVATE CLINIC:

Involve a deterioration of the state general.

Clinical inflammatory syndrome:

• Hot Ignition, red painful

• Night Alarm clock by the pain

• Improvement in the course of the day

Progressive or acute beginning.

Pseudo-grippal syndrome.

Intense pain ±. Reached the belts:

• Especially scapular

• Secondarily pelvic

The first sign at the old subject is a deterioration of the state general.

3) EXAMINATIONS:

Biology: sedimentation test high

Radiology: no ostéo-articular destruction.

Spontaneous cure within 3 year.

No articular after-effects.

But one can have an evolution prolonged on 5 to 6 years.

The repetitions are not rare.

4) TREATMENT:

a) Basic:

• Corticoids

• Salts of gold

• SALAZOPYRINE

• MÉTHOTREXATE

Analgesics to treat the pain.

To improve comfort of life.

b) Local treatments:

Kinesitherapy.

Corticoid infiltrations.

Surgery: prosthesis, arthrodèse.

5) DIAGNOSIS:

a) Very difficult at the early stage:

It is the topography, the clinical history and the radiology which will direct it.

Standard biological assessment.

Puncture: no crystals.

b) Differential diagnosis:

• Digital Osteoarthritis

• Chondrocalcinose

• Parkinson's disease: no radiological sign

• Scleroderma

c) Forms without deformation:

• Chondrocalcinose

• Amylose

• Rheumatisms paraneoplasic

• Connectivities

d) Forms at acute beginning:

• Lupus

• Endocarditis of Osler

• Septicaemia

B - THE DISEASE OF HORTON:

1) DEFINITION:

Unknown etiology.

Incidence for 100.000 people:

• 1,5 between 50 and 59 years

• 28,1 between 70 and 79 years

• 30 to 55 for the subjects of more than 80 years

Anatomo-physiological definition: side-arteritis diffuses but segmentary.

It can reach all the arteries.

Touch the median stock of the wall of the arteries.

But only certain segments.

The diagnosis is given by the biopsy of the temporal artery.

But one can fall on a healthy part of the wall of the artery.

2) CLINICAL SIGNS:

Monosymptomatic forms poly, oligo or:

Preferential attack of the temporal artery.

Signs:

• Cephalgias

• Hyperesthésie of the scalp

• Eye trouble

• Ulceration of the scalp

• Eye trouble: risk blindness (major complication)

Irreversible character.

Behavioral problems when the attack is extended to the carotid.

Associated vascular ischaemic accidents.

Necrose language.

Limping of the jaw.

Hémiplégie.

Aphasia.

Attack of coronary being able to cause a myocardial infarction.

Biologically, there are thus signs which are nonspecific.

The diagnosis is given by the biopsy.

3) TRAPS TO BE AVOIDED:

• To bring back the symptoms to reached rhumatologic

• To attach the vascular symptoms

• Not to pass beside a tuberculosis or from a disease of Osler

Evolution in the absence of treatment:

• 50% of blindnesses

• 10% of death by cachexy

4) TREATMENT:

a) Treatment by corticoids:

• Calms the pain

• Treats the inflammatory syndrome

• Vascular Consequences

Side effects:

• Gastric Problems

• Cutaneous Eruptions

• Induced Diabetes

• HTA

• Ponderal Overload by hydrosodée retention

• Behavioral problems

• Risk of depression or syndrome maniac

• Acne

• Alopécie

• Necroses aseptic irreversible femoral head

• Confusional Syndrome

b) Others:

Aspirine. AINS.

Evolution under treatment: cure without after-effects nor relapse.

Treatment by vitamin D for calcium. Gastric protection.

C - THE CHONDROCALCINOSE:

Caused by the presence of crystals of pyrophosphate of calcium or dicalcium phosphate on the level of the articulations, in the synovial pockets.

Cause an inflammatory syndrome.

1) CAUSES:

• Hémochromatose

• Drop

• Primary education Hyperparathyroïdie

2) LOCALIZATION:

• Knee +++

• Wrists: specific to the old subject

• Pubis

• Rachis

The diagnosis is given by the puncture.

3) TREATMENT:

a) Corticoids

b) Preferably: AINS

Shorter treatment: 5 to 10 days of treatment.

c) Colchicine

Evolution towards the cure.

D - PRIMARY HYPERPARATHYROÏDIE:

Had with an adenoma on the level of the parathyroid ones.

Attend before 60 years.

Involve a diffuse demineralization.

The patients consult for a AEG due to the hypercalcemy:

• Confusional Syndrome

• The patients drink and urinate much

Increase in the calcemy.

Increase in the calciurie.

Decreased phosphaturia.

The treatment is surgical: ablation of the adenoma.

E - The SECONDARY HYPERPARATHYROÏDIE:

Caused by:

• Renal Insufficiency

• Deficiency in vitamin D +++

• Deficiency out of calcium

Treatment of the cause.

F - ALGONEURODYSTROPHIE:

1) DEFINITION:

Articular pathology.

Generally the remote consequence of a traumatism.

But also:

• Hyperthyroïdie

• Hémiplégie

• Drugs: barbiturates, isoniasides

2) SIGNS:

• Pain

• Oedema

• Disorders vasomoteurs: hot hands then cold

• Painful articular Stiffness

3) TREATMENT:

• CALCITONINE

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