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assessing fall risk Flashcards

1
Q

what is the leading cause of injury and death in those over 65 y.o.

A

falls: 55%

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2
Q

T/F: falls are the most common cause of nonfatal injuries and hospital admissions for trauma

A

True

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3
Q

How common do falls lead to severe injuries?

A

1/5

20-30% of falls experience lacerations, hip fxs, head trauma

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4
Q

Many people who fall, even uninjured, develop a fear of falling. Why is this a concern

A
  1. downward spiral of inactivity
  2. decreased strength, agility, balance
  3. loss of independence
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5
Q

T/F: falls are an inevitable part of aging

A

False

Modifiable impairments = prevention!

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6
Q

recurrent faller

A

2 or more falls in 6-12 months

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7
Q

Intrinsic RF for falls

A
  1. gait/balance impairment
  2. peripheral neuropathy
  3. vestibular dysfunction
  4. muscle weakness
  5. vision impairment
  6. medical illness
  7. advanced age
  8. impaired ADLs
  9. orthostasis
  10. dementia
  11. drugs
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8
Q

extrinsic RF for falls

A
  1. environmental hazards
  2. poor footwear
  3. restraints
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9
Q

Precipitating causes for falls

A
  1. trips/slips
  2. drop attack
  3. syncope
  4. dizziness
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10
Q

Postural control

A

COG over BOS in static and dynamic situations

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11
Q

CNS strategies for posture control

A
  1. ankle
  2. hip
  3. stepping
  4. reaching
  5. suspensory
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12
Q

NM affects on posture control w/aging

A

response to balance perturbation affected by:

  • muscle str
  • endurance
  • latency
  • torque
  • power
  • flexibility
  • ROM
  • postural alignment
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13
Q

Best practice for AT-RISK older aduls

A
  1. ask about falls within past 12 months
  2. assess strength, balance, and gait
  3. assess for need of AD prescription
  4. provide supervised, structured exercise program
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14
Q

Best practice for those who have had 2+ falls in past year

A
  1. basic falls hx
  2. assess for OH
  3. assess visual activity
  4. assess strength, balance, gait
  5. home assessment for fall hazards
  6. review meds
  7. assess appropriateness of AD
  8. assess cog status
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15
Q

have you fallen?

if yes:

A

how many times in past month?

how many in the past 6 months?

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16
Q

Can you tell me what happened to cause you to fall?

A

If they cannot tell you why they fell: red flag for further questions

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17
Q

Did someone see you fall?

if yes:

A
  • did you have a loss of consciousness?
  • if yes: make sure their PCP is aware
  • often have bppv with hit to head
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18
Q

other questions to ask about falling

A
  • 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?
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19
Q

Visual exam of postural control

A
  • acuity
  • contrast sensitivity
  • depth perception
  • visual field cut
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20
Q

Vestibular exam of postural control

A
  • nystagmus
  • saccades
  • smooth pursuit
  • head impulse test
  • head shake test
  • dynamic visual acuity
  • skew deviation
  • VOR cancellation
21
Q

Somatosensory exam of postural control

A
  • cutaneous sensation
  • proprioception
  • vibration
22
Q

Sensory Integration exam of postural control

A

CTSIB

conditions 5-6 = vestibular dysfunction

conditions 4-6 = surface dependence

23
Q

Aerobic endurance exam of postural control

A

6MWT

24
Q

Environment exam of postural control

A

home safety checklist

25
Q

psychosocial exam of postural control

A
  • memory deficits
  • dementia
  • depression increase fall risk
26
Q

Fear of Falling exam of postural control

A
  • ABC scale

- FES-I

27
Q

When you see a stepping strategy:

A

COG displaced beyond limits of BOS

28
Q

when you see a reaching strategy

A

reaction to large perturbation

29
Q

suspensory strategy

A

lowers COG to enhance postural stability

30
Q

balance interventions

A
  1. reactive and proactive postural responses
  2. static/dynamic conditions
  3. LOS
  4. tai chi
  5. vestibular training
31
Q

Strength, ROM, and endurance exercises for fall prevention

A
  • LE strengthening
  • multidimensional program
  • function based
  • at least 10 week duration
32
Q

AD interventions for fall prevention

A
  • choose most appropriate AD
  • hip pads
  • proper footwear
  • facilitatory insole
  • vibrating insole
33
Q

balance and gait tech fall prevention

A
  • wearables
  • vibrotactile feedback
  • group exercise via tablet
  • VR exercises
34
Q

Home evaluation

A

key to fall prevention

  • explore potential RF
  • ID necessary changes
  • ID sources of payment and other potential resources
  • locate quality supplies and qualified installers
35
Q

3 parts of the home eval assessment

A
  1. assess commonly used areas inside/outside
  2. observe the person moving around in the environment
  3. determine the person’s fall risk and health status
35
Q

3 parts of the home eval assessment

A
  1. assess commonly used areas inside/outside
  2. observe the person moving around in the environment
  3. determine the person’s fall risk and health status
36
Q

dimensions for ramp

A

1 inch rise

12 inch run

37
Q

What are some characteristics of functional performance testing?

A
  1. objective, accurate record
  2. measures what is pertinent to patient
  3. informs impairments
  4. informs goal setting.
  5. comparison of age based normative data
  6. prognostic
38
Q

limitations of MMT in older adults

A
  • 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
39
Q

Outcome Measures:

self-report

A
  • patient perception of impairment, function, QOL

- Falls efficacy scale

40
Q

functional outcome measures:

patient outcome measure

A

asks patient about impact of condition on activities and roles in life

DASH

41
Q

functional outcome measures:

observer related measures

A

measures observed by PT

BESTest

42
Q

functional outcome measures:

physiological measures

A
  • measures single biological entity

BORG RPE

43
Q

functional outcome measures:

considerations

A
  1. validity and reliability
  2. floor/ceiling effect
  3. MDC
  4. MCID
  5. sensitivity/specificity
  6. (+) and (-) likelihood ratios
44
Q

walking tests

A
  1. 2MWT
  2. 6MWT
  3. DGI
  4. FGA
  5. TUG
  6. figure 8
45
Q

mobility scales

A
  1. 30 sec CRT
  2. 5/10 x STS
  3. floor transfer
46
Q

Balance tests

A
  1. BESTest
  2. BBS
  3. ABC scale
  4. functional reach
  5. 4 square step
  6. tinetti
  7. SLS
47
Q

Physical Performance Tests

A
  1. physiological profile assessment
  2. Short physical performance battery
  3. grip strength
48
Q

multidisciplinary fall risk tools

A
  1. morse fall scale

2. hendrich II fall risk model

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