2.4. Geriatrics - Immobility and Falls

Question 1

What are the Outcomes after a Fall?

Answer 1

1. Injury - Soft Tissue / Fracture / Subdural Haemorrhage
2. Rhabdomyolysis (Increased CK)
3. Loss of Confidence - Fear of Falling Syndrome
4. Inability to Cope
5. Dependence / Decreased QoL
6. Carer Stres
7. Institutionalisation
8. Terminal Decline

Question 2

What are the Risk Factors for a Fall?

Answer 2

1. Muscle Weakness / Arthritis
2. History of Falls
3. Gait / Balance / Visual Deficit
4. Use Assistive Device
5. Cognitive Impairment / Depression

Question 3

What are the Factors effecting people Falling?

Answer 3

1. Intrinsic Factors
2. Situational Factors
3. Extrinsic Factor

Question 4

What are the Intrinsic Factors which affect people Falling?

Answer 4

1. Gait / Balance Problems - Postural Instability / Vertigo
2. Syncope - Cardiac / Vagal / Other
3. Chronic Disease - Neuro / MSK
4. Visual Problems
5. Acute Illness
6. Cognitive Disorder
7. Vitamin D Deficiency

Question 5

What are the Situational Factors which affect people Falling?

Answer 5

1. Medications - Anti-Depressants / Antipsychotics / Anticholinergics / Anti-hypertensives / Benzodiazepines
2. Alcohol
3. Urgency of Micturition

Question 6

What are the Extrinsic Factors which affect people Falling?

Answer 6

1. Inappropriate Footwear
2. Poor Lighting
3. Environmental Hazards - Uneven Paving / Carpets / Walking Aids / Stairs

Question 7

How is Gait and Balance Assessed?

Answer 7

1. Siting to Standing Ability / Transfers / Gait
2. Romberg tests
3. Static / Dynamic Standing Balance - Functional Reach / Tandem / Timed Walk

Question 8

What are causes of Dizziness?

Answer 8

1. Unsteadiness
2. Vertigo:
3. a) Labyrinthitis
4. b) Acute Ear Infection
5. c) Benign Paroxysmal Positional Vertigo
6. d) Menieres
7. e) Cerebellar / Brainstem Pathology

Question 9

What are the Causes of Syncope?

Answer 9

1. Neurally-Mediated (Reflex) - Vasovagal / “Situational” Syncope
2. Orthostatic Hypotension - Autonomic Failure / Volume Depletion
3. Cardiac Arrythmias
4. Structural Cardiac / Cardiopulmonary Disease
5. Cerebrovascular

Question 10

How is Syncope Assessed?

Answer 10

1. History - Prodromal / Conscious / Previous Episodes
2. Collateral History - Circumstance / Posture / Appearance / Movement / Tongue Biting / Duration / Confusion / Unilateral Weakness
3. Examination - Vital Signs / Neuro + Cardio Exam
4. 12 Lead ECG

Question 11

How can Acute Ilness (“Off Legs”) cause Falls?

Answer 11

1. Limited Cerebral Functional Reserve
2. Hypoxia - Impaired Central Processing of Information
   Note - Usually secondary to Acute Illness (Infection / Dehydration) and Usually Reversible

Question 12

What Cognitive Disorders increase the Likelihood of Falls?

Answer 12

1. Dementia - Impaired Judgement / Abnormal Gait
2. Delirium
3. Depression / Anxiety - Precipitate Immobility

Question 13

What Medical Professionals are involved in Assessing Geriatrics for Risks of Falls?

Answer 13

1. Consultant Geriatrician
2. Doctors
3. Nurses
4. Physiotherapists
5. Occupational Therapists

Question 14

What is the Relationship between Immobility and Falls?

Answer 14

They Overlap:
Immobility - Sarcopenia (Muscle Mass Loss) / Elimination Problems
Can Lead To
Falls - Loss of Confidence / Injury / Pain
Can Lead to Immobility etc.

Question 15

What are the causes of Sarcopenia?

Answer 15

DECLINE:
Diabetes / Insulin Resistance
Elderly
Chronic Disease
Lack of Use
Inflammation
Nutritional Deficiency
Endocrine Dysfunction