assessing fall risk Flashcards
what is the leading cause of injury and death in those over 65 y.o.
falls: 55%
T/F: falls are the most common cause of nonfatal injuries and hospital admissions for trauma
True
How common do falls lead to severe injuries?
1/5
20-30% of falls experience lacerations, hip fxs, head trauma
Many people who fall, even uninjured, develop a fear of falling. Why is this a concern
- downward spiral of inactivity
- decreased strength, agility, balance
- loss of independence
T/F: falls are an inevitable part of aging
False
Modifiable impairments = prevention!
recurrent faller
2 or more falls in 6-12 months
Intrinsic RF for falls
- gait/balance impairment
- peripheral neuropathy
- vestibular dysfunction
- muscle weakness
- vision impairment
- medical illness
- advanced age
- impaired ADLs
- orthostasis
- dementia
- drugs
extrinsic RF for falls
- environmental hazards
- poor footwear
- restraints
Precipitating causes for falls
- trips/slips
- drop attack
- syncope
- dizziness
Postural control
COG over BOS in static and dynamic situations
CNS strategies for posture control
- ankle
- hip
- stepping
- reaching
- suspensory
NM affects on posture control w/aging
response to balance perturbation affected by:
- muscle str
- endurance
- latency
- torque
- power
- flexibility
- ROM
- postural alignment
Best practice for AT-RISK older aduls
- ask about falls within past 12 months
- assess strength, balance, and gait
- assess for need of AD prescription
- provide supervised, structured exercise program
Best practice for those who have had 2+ falls in past year
- basic falls hx
- assess for OH
- assess visual activity
- assess strength, balance, gait
- home assessment for fall hazards
- review meds
- assess appropriateness of AD
- assess cog status
have you fallen?
if yes:
how many times in past month?
how many in the past 6 months?
Can you tell me what happened to cause you to fall?
If they cannot tell you why they fell: red flag for further questions
Did someone see you fall?
if yes:
- did you have a loss of consciousness?
- if yes: make sure their PCP is aware
- often have bppv with hit to head
other questions to ask about falling
- did you go to the dr as a result of your fall or did you go to ER?
- did you get hurt?
- what direction did you fall?
- did you recently change any of your meds?
Visual exam of postural control
- acuity
- contrast sensitivity
- depth perception
- visual field cut
Vestibular exam of postural control
- nystagmus
- saccades
- smooth pursuit
- head impulse test
- head shake test
- dynamic visual acuity
- skew deviation
- VOR cancellation
Somatosensory exam of postural control
- cutaneous sensation
- proprioception
- vibration
Sensory Integration exam of postural control
CTSIB
conditions 5-6 = vestibular dysfunction
conditions 4-6 = surface dependence
Aerobic endurance exam of postural control
6MWT
Environment exam of postural control
home safety checklist
psychosocial exam of postural control
- memory deficits
- dementia
- depression increase fall risk
Fear of Falling exam of postural control
- ABC scale
- FES-I
When you see a stepping strategy:
COG displaced beyond limits of BOS
when you see a reaching strategy
reaction to large perturbation
suspensory strategy
lowers COG to enhance postural stability
balance interventions
- reactive and proactive postural responses
- static/dynamic conditions
- LOS
- tai chi
- vestibular training
Strength, ROM, and endurance exercises for fall prevention
- LE strengthening
- multidimensional program
- function based
- at least 10 week duration
AD interventions for fall prevention
- choose most appropriate AD
- hip pads
- proper footwear
- facilitatory insole
- vibrating insole
balance and gait tech fall prevention
- wearables
- vibrotactile feedback
- group exercise via tablet
- VR exercises
Home evaluation
key to fall prevention
- explore potential RF
- ID necessary changes
- ID sources of payment and other potential resources
- locate quality supplies and qualified installers
3 parts of the home eval assessment
- assess commonly used areas inside/outside
- observe the person moving around in the environment
- determine the person’s fall risk and health status
3 parts of the home eval assessment
- assess commonly used areas inside/outside
- observe the person moving around in the environment
- determine the person’s fall risk and health status
dimensions for ramp
1 inch rise
12 inch run
What are some characteristics of functional performance testing?
- objective, accurate record
- measures what is pertinent to patient
- informs impairments
- informs goal setting.
- comparison of age based normative data
- prognostic
limitations of MMT in older adults
- ceiling effect in available strength
- “make tests” have inaccuracies of available str
- “break tests” can be aggressive
- subjective grading
- patient effort, understanding, willingness affect results
Outcome Measures:
self-report
- patient perception of impairment, function, QOL
- Falls efficacy scale
functional outcome measures:
patient outcome measure
asks patient about impact of condition on activities and roles in life
DASH
functional outcome measures:
observer related measures
measures observed by PT
BESTest
functional outcome measures:
physiological measures
- measures single biological entity
BORG RPE
functional outcome measures:
considerations
- validity and reliability
- floor/ceiling effect
- MDC
- MCID
- sensitivity/specificity
- (+) and (-) likelihood ratios
walking tests
- 2MWT
- 6MWT
- DGI
- FGA
- TUG
- figure 8
mobility scales
- 30 sec CRT
- 5/10 x STS
- floor transfer
Balance tests
- BESTest
- BBS
- ABC scale
- functional reach
- 4 square step
- tinetti
- SLS
Physical Performance Tests
- physiological profile assessment
- Short physical performance battery
- grip strength
multidisciplinary fall risk tools
- morse fall scale
2. hendrich II fall risk model
