1: Falls Flashcards
What are the geriatric giants
- Immobility
- Instability
- Impaired cognition
- Inability to complete ADL
- Incontinence
define a fall
Unintentional, unexpected loss of balance where someone comes to rest on the ground, floor or object below knee level
what mnemonic is used to remember the cause of falls
A C E
Age related
Co-morbidities
Environment
Name 5 age-related changes that may lead to falls
- Loss of neurons
- Demyelination of neurons
- Sensory impairment
- Impaired vestibular system
- Sarcopenia
- Posture
- Gait
- Long sightedness
Name 3 ways a gait may change with age
Reduced stride length
Less use of hip flexors and extensors
Reduced speed
What co-morbidities may lead to falls that affect balance
Parkinson's disease Stroke Neuropathy Vestibular disorder Arthritis
What 3 co-morbdities causing visual impairment may lead to falls
Cataracts
Glaucoma
Retinopathy
What cardiovascular conditions may cause falls
Valvular heart disorders
Arrhythmias
Carotid sinus syndrome
What other co-morbidities may lead to falls
Delirium + Dementia = forget walking aid
Incontinence = rush to toilet
What are 5 drugs that may lead to falls
- benzodiazepines
- Z drugs
- TCA
- B blockers
- A blockers
- ACEi
- Antihistamines
- Anti-epileptics
- Opioids
What two types of patients have been deemed at risk of falling in hospitals
- > 65y
2. 50-64 with other co-morbidity that makes them at an increased risk of falls
How should all elderly people receiving medical attention for a fall be assessed
Multifactoral Falls Risk Assessment
What are the 3 criteria for a multifactoral falls risk assessment
- Sought medical attention for a fall
- Recurrent falls
- Present with gait or balance abnormality
What 10 items does a multifactoral falls risk assessment include
- Fall Hx
- Cardiovascular exam
- Gait, balance assessment
- Osteoporosis risk
- Visual impairment
- Cognitive impairment
- Ask about incontinence
- Medication review
- Older persons fear of falling
- Home hazards review
What other 3 tests may a elderly person presenting with falls undergo
- Lying-Standing BP
- Urinalysis
- X-ray of damaged part
What is a positive lying-standing BP result
A postural drop of >20/10mmHg
What is the main ‘preventative’ method for falls
If an individual >65y presents to healthcare - they should be asked how many times they’ve fallen int he past year
How are falls managed in elderly people
Mutlifactoral Fall Intervention
Falls prevention program
What are the 4 elements of a multifactoral falls intervention
- Medication review
- Strength + Balance training
- Vision assessment
- Home hazard assessment
What is the prognosis of falls in elderly people
Leading cause of injury related death in the elderly
What are 2 injurous outcomes of falls in the elderly
Head Injury
Fractures (commonly fractured neck of femur)
What % of elderly patients die in 1m
10%
What % of elderly patients with hip fractures die in one year
1/3
What % of elderly patients are permanently disabled following a hip fracture
50%
What are the psychological impacts of a fall
Reduced confidence
Reduced independence
Low mood
Lonliness
What are the secondary injuries that can come from a fall
Rhabdomyolysis Pressure sore Chest infection Dehydration Muscle atrophy Hypothermia Burns
