1: Falls

Question 1

What are the geriatric giants

Answer 1

1. Immobility
2. Instability
3. Impaired cognition
4. Inability to complete ADL
5. Incontinence

Question 2

define a fall

Answer 2

Unintentional, unexpected loss of balance where someone comes to rest on the ground, floor or object below knee level

Question 3

what mnemonic is used to remember the cause of falls

Answer 3

A C E
Age related
Co-morbidities
Environment

Question 4

Name 5 age-related changes that may lead to falls

Answer 4

• Loss of neurons
• Demyelination of neurons
• Sensory impairment
• Impaired vestibular system
• Sarcopenia
• Posture
• Gait
• Long sightedness

Question 5

Name 3 ways a gait may change with age

Answer 5

Reduced stride length

Less use of hip flexors and extensors

Reduced speed

Question 6

What co-morbidities may lead to falls that affect balance

Answer 6

Parkinson's disease
Stroke 
Neuropathy 
Vestibular disorder 
Arthritis

Question 7

What 3 co-morbdities causing visual impairment may lead to falls

Answer 7

Cataracts
Glaucoma
Retinopathy

Question 8

What cardiovascular conditions may cause falls

Answer 8

Valvular heart disorders
Arrhythmias
Carotid sinus syndrome

Question 9

What other co-morbidities may lead to falls

Answer 9

Delirium + Dementia = forget walking aid

Incontinence = rush to toilet

Question 10

What are 5 drugs that may lead to falls

Answer 10

• benzodiazepines
• Z drugs
• TCA
• B blockers
• A blockers
• ACEi
• Antihistamines
• Anti-epileptics
• Opioids

Question 11

What two types of patients have been deemed at risk of falling in hospitals

Answer 11

1. > 65y

2. 50-64 with other co-morbidity that makes them at an increased risk of falls

Question 12

How should all elderly people receiving medical attention for a fall be assessed

Answer 12

Multifactoral Falls Risk Assessment

Question 13

What are the 3 criteria for a multifactoral falls risk assessment

Answer 13

1. Sought medical attention for a fall
2. Recurrent falls
3. Present with gait or balance abnormality

Question 14

What 10 items does a multifactoral falls risk assessment include

Answer 14

1. Fall Hx
2. Cardiovascular exam
3. Gait, balance assessment
4. Osteoporosis risk
5. Visual impairment
6. Cognitive impairment
7. Ask about incontinence
8. Medication review
9. Older persons fear of falling
10. Home hazards review

Question 15

What other 3 tests may a elderly person presenting with falls undergo

Answer 15

1. Lying-Standing BP
2. Urinalysis
3. X-ray of damaged part

Question 16

What is a positive lying-standing BP result

Answer 16

A postural drop of >20/10mmHg

Question 17

What is the main ‘preventative’ method for falls

Answer 17

If an individual >65y presents to healthcare - they should be asked how many times they’ve fallen int he past year

Question 18

How are falls managed in elderly people

Answer 18

Mutlifactoral Fall Intervention

Falls prevention program

Question 19

What are the 4 elements of a multifactoral falls intervention

Answer 19

1. Medication review
2. Strength + Balance training
3. Vision assessment
4. Home hazard assessment

Question 20

What is the prognosis of falls in elderly people

Answer 20

Leading cause of injury related death in the elderly

Question 21

What are 2 injurous outcomes of falls in the elderly

Answer 21

Head Injury

Fractures (commonly fractured neck of femur)

Question 22

What % of elderly patients die in 1m

Answer 22

10%

Question 23

What % of elderly patients with hip fractures die in one year

Answer 23

1/3

Question 24

What % of elderly patients are permanently disabled following a hip fracture

Answer 24

50%

Question 25

What are the psychological impacts of a fall

Answer 25

Reduced confidence
Reduced independence
Low mood
Lonliness

Question 26

What are the secondary injuries that can come from a fall

Answer 26

Rhabdomyolysis
Pressure sore
Chest infection
Dehydration
Muscle atrophy 
Hypothermia
Burns