B6-075 CBCL Geriatric Fall-Pelvic Fracture Flashcards
DEATTH pneumonic for ADLs required for independent living
Dressing
Eating (actually feeding self)
Ambulating
Transfers
Toileting
Hygiene (don’t have to do this to live on your own, you can have someone help)
SHAFTTT pneumonic for IADLs
Shopping
Housekeeping
Accounting
Food prep
Telephone
Transportation
Taking medications
advanced ADLs
working
recreational activity
functional assessment AGING GAMES pneumonic
Audiovisual
Gait/mobility
Insomnia
Nutrition
GI
GU
ADLs/advance directive
Mood/memory
Environment/everyday activities
Sexuality
ultimate goal of inter-professional geriatric care
maximize independence
biggest risk factors for falls [2]
history of falls
fear of falling (causes gait disorders, less leaving house, anxiety, etc)
types of medications that can cause increased risk of fall [5]
blood pressure (orthostatic hypotension)
diabetes (hypoglycemia)
benzodiazepines
SSRIs
anticholinergics
fall history should make sure to include
near falls
timed get up and go <10 s is
normal
timed get up and go >14 s is indicative of
increased risk of fall
timed get up and go >20 s is indicative of
more severe gait impairment
less than […] on function reach test is highly predictive of falls
7 inches
BLAST pneumonic for gait assessment
Base
Length of stride
Arm swing
Stance
Turn
[type of gait]
limited ROM, limping
slow short steps
unable to bear full weight
antalgic gait
[type of gait]
pain worsening with movement and weight bearing
antalgic gait
[type of gait]
caused by degenerative joint disease or trauma
antalgic gait
[type of gait]
staggering, wide-base
cerebellar ataxia
[type of gait]
dysarthia, tremor, Romberg sign
cerebellar ataxia
[type of gait]
caused by cerebellar degeneration, MS, stroke
cerebellar ataxia
[type of gait]
short stepped, shuffling
hips knees and spine flexed
festination, en bloc turns
parkinsonian
[type of gait]
absences of objective neurologic signs
give-way weakness
parkinsonian
[type of gait]
caused by Parkinson’s disease
parkinsonian
:)
[type of gait]
results from foot drop
excessive flexion of hips/knees when walking
short strides
slapping quality
tripping
steppage
[type of gait]
atrophy of distal leg muscles
distal sensory loss and weakness
footdrop
loss of ankle jerk
steppage
[type of gait]
caused by motor neuropathy or sensory ataxia
steppage
[type of gait]
wacky, wobbly, wet due to sensory ataxia
normal pressure hydrocephalus
keys to fall prevention [2]
- multifactorial risk assessment and intervention
- anticipatory guidance
describe patient presentation with hip fracture
groin pain
unable to bear weight
displaced: shortened leg, external rotation, abduction
+ log roll
rarely bruising
initial imaging for hip fracture
lateral and AP pelvis Xray
if Xray is negative but the pain persists, what imaging modality should be used?
MRI
types of extracapsular fracture [2]
intertrochanteric
subtrochanteric
types of intracapsular fracture [2]
femoral head
femoral neck
most important initial treatment for hip fracture
analgesia
hips fractures should be treated within […] to increase chances of improved mobility
24-48 hrs
treatment of intertrochanteric fractures
ORIF or arthroplasty
fx occurring in cancellous bone with good blood supply, but has a high rate of failure due to being a high stress area
subtrochanteric
treatment of subtrochanteric fractures
IM rod/nail
fx associated with higher risk of AVN or nonunion due to poor blood supply
femoral head and neck fractures
treatment of femoral head/neck fracture
ORIF vs arthroplasty
ORIF: lower mortality, less blood loss, fewer infections
arthroplasty: lower re-operation rates, less AVN/malunion, earlier recovery
components of gait assessment [2]
timed get up and go
functional reach
how is treatment of a hip fracture decided? [3]
location of fracture
patient’s co-morbid conditions
risk vs benefit ratio
some interventions for a person at risk of falls
physical/occupational therapy
walkers, other DME
daily exercise
Tai Chi
what is used to avoid pulmonary embolism after surgery?
anticoagulation therapy
SCDs
what techniques are used to avoid delirium after surgery?
minimal medications
keeping home schedule
frequent orientation
[…] is key to retaining mobility post-operatively
early ambulation with PT
what long term medications should be considered post-operatively to decrease the risk of subsequent fractures?
calcium
vitamin D
bisphophonates
:)
patients with function decline due to frailty most commonly loose their ADLs in what order?
Hygiene
Dress or Toilet
Walk
Feed
**dress/toilet is inconsistent
the only ADL that a person can need help with and still live in their own home alone is
hygiene
goals of functional assessment
optimize independence by identifying and treating impairments early
biggest risk factor for falling
history of falls
second biggest risk factor for falling
fear of falling
most comprehensive evaluation for gait assessment
timed get up and go
pain that worsens with extension (going up stairs) and improves with flexion is characteristic of
spinal stenosis
confused
gait instability
urinary incontinence
is characteristic of
normal pressure hydrocephalus
**wacky, wobbly, wet
festinating gait is associated with
parkinsonism
in a confused patient with acutely altered gait, what should you consider?
vision impairment (apparently 🙄)
near-falling upon waking up is likely due to
orthostatic hypertension
gait test useful for ataxia and imbalance
Romberg
if the patient has a normal gait, what gait test is most appropriate?
Tandem walk
gait indicative of pain/trauma
antalgic
gait associated with osteoarthritis
antalgic
best initial step for a person with antalgic gait
referral to PT
associated with degenerative disease
most modifiable risk factor for preventing falls using a multifactorial approach
balance impairment
SSRIs considered to be safe in older adults [3]
sertaline
citalopram
escitalopram
SSRIs that increase fall risk significantly [2]
fluoxetine
paroxetine
**they are anticholingeric and have multiple drug interactions
sedative/hypnotic medication used for insomnia
zolpidem
strongly anticholinergic agent that effects balance and cognition
should almost never be used in older adults
diphenhydramine
best next step following abnormal timed get up and go test
multifactorial risk assessment with intervention
interventions shown to decrease fall risk in low-risk patients without fall history [3]
Tai Chi/exercise
environmental modifications if the patient is severely visually impaired
vitamin D supplementation
[…]% of hip fracture patients recover their ADLs
50%
[…]% of hip fracture patients walk independently again
50
[…]% of hip fracture patients move into long term care after
20
if she asks how you should respond to a patient, use […]
wish/worry statements
if initial Xray is negative but patient has ongoing hip pain following fall, what is the next best step?
MRI
or bone scan
in a hip fracture patient, surgery should be done within […] to speed functional recovery
24-48 hrs
treatment for isolated trochanteric avulsion fracture
non-weight bearing for 3-4weeks
follow up with Xrays to assess for displacement/healing
following trochanteric avulsion fracture, patients can usually resume full activity at
3-4 months
LMWH should be started […] hours prior to surgery
12
given preoperatively to reduce the risk of bleeding and prevent DVT formation
LMWH
[…] should be given following treatment of hip fracture, regardless of bone density
bisphosphonates
[…] should be given 1-2 hours prior to surgery
antibiotics (cefazolin)
**vancomycin if the patient is allergic to cephalosporins
[…] should be given every 8 hours for 24 hours after surgery to prevent infection
antibiotics (cefazolin)
**vancomycin if the patient is allergic to cephalosporins
safest assistive device following hip fracture
roller walker
first ADL typically lost
bathing
last ADL typically lost
feeding
