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Year 4 TCDs > Ageing: Falls > Flashcards

Ageing: Falls Flashcards

1
Q

Name 10 causes of falls in the elderly (in order of likelihood)

A
  1. Environment related
  2. Gait/balance disorders or weakness
  3. Specified causes (arthritis, acute illness, drugs, alcohol, pain, epilepsy, falling from bed)
  4. Dizziness/vertigo
  5. Drop attack (vertebrobasilar insufficiency)
  6. Confusion
  7. Postural hypotension
  8. Visual disorder
  9. Syncope
  10. Unknown
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2
Q

List 8 risk factors for falls in the elderly

A
  1. Weakness
  2. Balance deficit
  3. Gait deficit
  4. Visual deficit
  5. Mobility limitation
  6. Cognitive impairment
  7. Impaired functional status
  8. Postural hypotension
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3
Q

List 5 common symptoms elderly patients may experience before a fall

A
  1. Dizziness/giddiness
  2. Palpitations
  3. Incontinence/tongue-biting
  4. Asymmetric weakness
  5. Chest pain
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4
Q

List 5 fall differentials for a patient presenting with dizziness/giddiness

A
  1. Orthostatic hypotension
  2. Vestibular problem
  3. Hypoglycemia
  4. Arrhythmia
  5. Drug-side effect
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5
Q

List a fall differential for an elderly presenting with palpitations

A

Arrhythmia

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6
Q

List a fall differential for an elderly patient presenting with incontinence/tongue-biting

A

Seizure

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7
Q

List a fall differential for an elderly patient presenting with asymmetrical weakness

A

Cerebrovascular disease

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8
Q

List 2 fall differentials for an elderly patient presenting with chest pain

A
  1. MI

2. Coronary insufficiency

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9
Q

What 9 things are important to investigate in the post-fall physical examination?

A
  1. Orthostatic changes in pulse + BP
  2. Presence of arrhythmia
  3. Carotid bruits
  4. Nystagmus
  5. Focal neurological signs
  6. Weakness/MSK abnormalities
  7. Visual loss
  8. Gait disturbances
  9. Cognitive dysfunction
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10
Q

What 7 laboratory tests are often useful when investigating the cause of a fall in the elderly?

A
  1. FBC
  2. U&Es
  3. Blood glucose
  4. ECG
  5. Lying + standing BP
  6. Gait assessment
  7. Bone profile
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11
Q

Name 2 drug therapies used for postural hypotension

A
  1. Fludrocortisone (mineralocorticoid)

2. Midodrine (a-1 agonist)

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12
Q

How is absolute risk of fragility fracture measured?

A

FRAX or QFracture

- Estimate 10-year major osteoporotic/hip fracture risk

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13
Q

What is the best preventative option for fragility fractures?

A

Bisphosphonates

  • Alendronic acid 70mg once weekly
  • Calcium + vitamin D supplements daily
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14
Q

What 6 components need to be covered in a falls history?

A
  1. Circumstances surrounding the fall (preceding symptoms)
  2. Medication history
  3. Vision assessment
  4. Cognition assessment
  5. Continence
  6. Risk factors for osteoporosis
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15
Q

The 4 main causes of falls can be remembered using the mnemonic DAME. What does this stand for?

A

D-drugs
A-ageing
M-medical causes
E-environmental

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16
Q

What 5 questions are important to ask a patient regarding what occurred BEFORE the fall?

A
  1. Where were they?
  2. What time of day?
  3. Is there a pattern to the falls?
  4. Any symptoms before falling?
  5. Why do they think they fell?
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17
Q

What 2 questions are important to ask a patient regarding what occurred DURING the fall?

A
  1. Did they lose consciousness?

2. Have they injured themselves?

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18
Q

What 3 questions are important to ask a patient regarding what occurred AFTER the fall?

A
  1. How did they get help?
  2. Were they able to get up?
  3. Have they suffered any complications (ie. long lie, head injury, fracture)?
19
Q

What is the pathophysiology of vertigo?

A

Problem in the vestibulo-labyrinthine system anywhere between the ear (peripheral vertigo) and the central vestibular pathways (central vertigo)

20
Q

What are 4 causes of peripheral vertigo?

A
  1. Benign Paroxysmal Positional Vertigo (BPPV)
  2. Menière’s Disease
  3. Vestibular neuritis
  4. Acoustic neuroma
21
Q

What are 4 causes of central vertigo?

A
  1. Migraine
  2. Brainstem ischemia
  3. Cerebellar stroke
  4. Multiple sclerosis
22
Q

How is BPPV diagnosed?

A

Dix-Hallpike Manœuvre

  • In BPPV, expect to see nystagmus within 30s of bringing the patient’s head down to 20º over the edge of the bed
  • Perform on both sides with head at 45º
23
Q

How is BPPV treated?

A

Epley Manoeuvre

  • Head is turned 90º from opposite shoulder
  • Head is turned the other way while patient turns onto their L side
  • Patient sits up with chin sitting on their chest to finish
24
Q

Outline the steps to accurately recording lying-standing BP (5)

A
  1. Ask patient to lie down for at least 5min
  2. Measure BP
  3. Ask patient to stand and measure BP within 1min
  4. Measure BP again after 3min of standing
  5. Repeat recording if BP still dropping
25
Q

What is a positive lying-standing BP result?

A
  1. A drop in systolic BP of 20mmHg or more (regardless of symptoms)
  2. A systolic drop below 90mmHg on standing, even if drop is less than 20mmHg (regardless of symptoms)
  3. A diastolic drop of 10mmHg with symptoms
26
Q

What system examination should be performed on a fall patient? (5)

A
  1. Upper/lower neuro exam + cognition assessment
  2. Vision/vestibular
  3. BP
  4. Cardiovascular exam
  5. MSK exam
27
Q

What results on a blood test would indicate mild dehydration? (2)

A
  1. Hyponatremia

2. Raised urea

28
Q

What 4 fall interventions has NICE suggested?

A
  1. Strength + balance training
  2. Home hazard assessment + intervention
  3. Vision assessment + referral
  4. Medication review with modification/withdrawal
29
Q

What age does NICE guidance suggest an assessment of fracture risk to be considered?

A
  • Any person > 50y with a fall history
  • All women > 65y
  • All men > 75y
30
Q

What 4 lifestyle factors contribute to osteoporosis?

A
  1. Smoking
  2. Alcohol
  3. Weight bearing exercise
  4. Drugs (steroids)
31
Q

What is a Colles fracture?

A

Complete fracture of the radius bone of the forearm close to the wrist resulting in an upward (posterior) displacement of the radius + obvious deformity

32
Q

What is sarcopenia?

A

Decreased muscle mass

33
Q

What are 3 main causes of sarcopenia?

A
  1. Hormonal loss (GH + testosterone)
  2. Denervation atrophy
  3. Inactivity
34
Q

What is the pathophysiology of postural hypotension?

A

Reduced baroreceptor sensitivity in old age

35
Q

What is the pathophysiology of osteoporosis in the elderly?

A

Reduced bone mineral density

36
Q

What is the equation used to describe BP?

A

BP = CO x PVR

37
Q

What is the equation used to describe cardiac output?

A

CO = HR x SV

38
Q

What are 4 cardiovascular-related pathophysiological causes that can increase an elderly patient’s risk of falls?

A
  1. Reduced baroreceptor sensitivity (blunt compensatory rise in HR)
  2. Renin-aldosterone system works less effectively (salt wasting + reduced blood volume)
  3. Left ventricular diastolic dysfunction (inability to increase SV)
  4. Conduction system disease (SA + AV node dysfunction prevent HR rise)
39
Q

What are the 4 stages in the repair of a broken bone?

A
  1. Hematoma formation at fracture site
  2. Fibrocartilaginous callus formation
  3. Bony callus formation (woven bone)
  4. Remodelling + addition of compact bone (lamellar bone)
40
Q

Name 2 investigations used to diagnose a central cause of vertigo

A
  1. Brain imaging

2. Lumbar puncture

41
Q

Name 2 interventions that have been proven to reduce the rate and risk of falls in the elderly

A
  1. Exercise programme

2. Home hazard assessment

42
Q

What special instructions must be given to a patient taking an oral bisphosphonate? (3)

A
  1. Take on empty stomach
  2. Remain upright for 30min
  3. Review therapy in 3-5years
43
Q

What are the 2 common and 2 rare/serious side effects of bisphosphonates?

A

Common:

  1. Heartburn
  2. Indigestion

Rare/Serious:

  1. Esophageal ulceration
  2. Gastric ulceration

Year 4 TCDs (16 decks)

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