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MBBS - Year 1 > Clinical skills - Old Age & Falls > Flashcards

Clinical skills - Old Age & Falls Flashcards

1
Q

Sensory mechanisms involved in balance

A

Vision
Proprioception
Tactile sense
Vestibular system

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2
Q

Types of balance

A

Static balance - standing

Dynamic balance - running, jumping etc

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3
Q

Adaptations to help us keep our balance

A

Ankle strategy
Hip strategy
Stepping
Arm movements

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4
Q

Ankle strategy to help keep balance

A

Uses muscles around ankle to correct loss of balance (static)

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5
Q

Hip strategy to help keep balance

A

Uses muscles around hip to correct loss of balance (static)

Corrects natural swaying

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6
Q

Stepping to keep balance

A

Changes base of support

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7
Q

Arm movements to help keep balance

A

Helps change centre of gravity

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8
Q

Stereoscopic vision

A

We have two slightly different view of same things due to our eye placement

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9
Q

Monocular vision

A

Seeing two different things (animals with eyes in side of head)

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10
Q

Things vision helps us detect

A

Distance
Movement
Orientation
Standing/ walking surface

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11
Q

Proprioception

A

Sense of position, movement, and force

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12
Q

Structures in body helping with proprioception

A

Stretch receptors in muscle and tendons

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13
Q

Mechanoreceptors in joints

A

Cervical spine

Hips, knees, ankles

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14
Q

What contributes to tactile sense

A

Deep pressure sensors in soles of feet

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15
Q

What reduces tactile sense

A

Standing on soft surfaces

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16
Q

What is vestibular system made up of

A

Otolith organs

Semi-circular canals

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17
Q

Function of otolith organs

A

Detect linear acceleration of head

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18
Q

Function of semi-ciciular canals

A

Detect angular acceleration due to endolymph

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19
Q

Vestibulo-optic reflex

A

Maintains visual fixation (despite head movement)

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20
Q

Vestibulo-spinal reflex

A

Keeps head level but can be overcome

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21
Q

Structures within cerebral cortex

A 
Primary motor cortex (M1) 
Premotor cortex
Supplementary motor area 
Parietal lobe 
Occipital lobe
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22
Q

Primary motor cortex function

A

Direct control, voluntary movement

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23
Q

Premotor cortex function

A

Motor acts linked to external stimulus

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24
Q

Supplementary motor area function

A

Internally curated motor acts

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25
Q

Parietal lobe function

A

Spatial awareness

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26
Q

Occipital lobe function

A

Visual perception

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27
Q

Basal ganglia role in balance

A

Timing cues for automatic movement

Postural reflexes

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28
Q

Cerebellum role in balance

A

Fine tunes postural adjustments
Makes ‘coarse adjustment’ for slow voluntary, movement
Coordinates rapid, ballistic movements

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29
Q

Reflexes that happen in the spinal cord

A

Stretch reflex

Crossed extensor reflex

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30
Q

Reflexes that happen in the brain stem

A

Maintenance of postural muscle tone

Righting reflexes

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31
Q

Aging effect on vision

A

Reduced acuity
Reduced contrast sensitivity
Reduced dark adaptation

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32
Q

Aging effect on sensation

A

Reduced proprioception

Reduced touch sensitivity in the foot

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33
Q

Aging effect on brain

A

Fewer neurones
Fewer nerve fibres
Slower reaction times
Impaired integration of sensory info

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34
Q

Aging effect on muscle

A

Reduced muscle mass
Reduced muscle strength
Slower contraction

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35
Q

Outcomes following a fall

A

Increased mortality, long term disability and earlier entry to residential care
Fragility fractures cost UK £4.4 billion over year

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36
Q

Who is targeted when giving out home assessments

A 
High risk fallers 
Fallen before in <1yr
Fall with injury 
Cognitive impairment 
Visual impairment 
Gait or balance impairment 
Fear of falling
Leaving a rehab setting particularly post neck fracture NOF
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37
Q

Purpose of home assessments

A

Identify home hazards and recommend or arrange modifications
Assess and modify performance and function
Identify and agree strategies to reduce falls risk
Education and information giving

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38
Q

What should older people who have received treatment in hospital following a fall be allowed

A

A home hazard assessment and safety intervention/ medications

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39
Q

Local pathways for accessing home assessment - primary care

A

Supported care to home incl OT home assessment
Community OT
Falls vehicle: paramedic and OT

40
Q

Local pathways for accessing home assessment - secondary care

A 
A+E 
OPED
OPAC
wards 
OPAS
41
Q

OPED

A

Older peoples emergency department, undergoes comprehensive geriatric assessment

42
Q

OPAC

A

Older peoples assessment centre (nurse led discharge centre)

43
Q

OPAS

A

Older peoples assessment service (consultant-led outpatient service)

44
Q

How much of our population is 60+

A

Over a 1/5

45
Q

What are the 3 broad groups older people belong to

A

Entering old age
Transitional phase – between a healthy active life and frailty
Frail older people

46
Q

Proportion of NHS budget spent on 60+

A

~40%

47
Q

Proportion of social service budget spent on 60+

A

~50%

48
Q

Proportion of general and acute beds used by those 65+

A

Almost 2/3

49
Q

NHS and social care action plan

A 
Improve standards of care 
Extend access to services 
Ensure fairer funding of long-term care 
Develop services which support independence
Help older people to stay healthy
50
Q

Frailty

A

Not an illness, but a syndrome that combines the effects of natural ageing with the outcomes of multiple long-term conditions, a loss of fitness and reserves

51
Q

Medical definition of frailty

A

Older people with 1/1+ chronic, long-term condition e.g heart disease, COPD
Older people who may not have a spp, diagnosed condition, but who may nevertheless require support from care services to live independently
and
Older people who are on the threshold of either of these two groups

52
Q

Frailty syndromes

A 
Deliriium 
Falls 
immobility - sudden change 
Continence problems 
Med management challenges
53
Q

MDT approach for older pt’s and falls

A 
GP & nursing team
Family 
Social care
OT
PT 
SLT
54
Q

MDT community services aim

A

Prevent Hosp admission - crisi management

55
Q

Aim of rapid response teams

A

To prevent admission and set up immediate short term intervention plan

56
Q

Consequences of hosp admission

A

Older people are at risk of deterioration

If admitted for inpatient hosp care, the oldest have readmission rates and highest rate of long-term care use after d/c

57
Q

Why are older people at risk of deterioration when admitted to hosp

A

Factors affecting this are the environment, care delivery and risks

58
Q

OT job role

A

identifies occupational performance issues & implement plans to facilitate independece

59
Q

SLT job role

A

Anticipates and responds to the needs of individuals who experience speech, language, communication or swallowing difficulties

60
Q

Activity limitation due to recurrent falls (+ subsequent injuries)

A

Not able to go out –> loss of social network and relationships

61
Q

Activity limitation due to Parkinson’s

A

Difficult swallowing food and gripping cutlery –> no longer feels able to go ut for a meal

62
Q

Age discrimination statistics

A

Experienced by 36.8% of people aged 65/ 65+
53% believe treated as a child
68% believe politicians see them as a low priority

63
Q

Social aspect of aging

A

Physical and mental decline are not inevitable in later life.
As people grow older, they work to maintain their own sense of personal identity.
People may experience the self as ‘younger’ than the body.
Dementia and Alzheimer’s disease do not necessarily mean loss of self

64
Q

Types of delirium

A

Hyperactive, hypoactive or mixed with features of both

65
Q

Hyperactive delierium

A

pt may have heightened arousal, agitation, aggression, restlessness

66
Q

Hypoactive delirium

A

presents with a withdrawn patient, that is quiet, with reduced oral intake decreased responsiveness and slowed motor skills.
More difficult to spot in a pt

67
Q

Priorities of managing a pt with confusion

A

Maintaining patient safety by removing from potential harm
Identifying and treating precipitants
Managing symptoms

68
Q

Importance of recognising delirium

A

Pts who develop delirium have worse outcomes
Longer periods of hospital stay
Increased risk of falls
Increased risk of pressure sores
Early recognition reduces these risks.
New confusion is now included in the NEWS early warning score

69
Q

Postural hypotension

A

A drop in systolic BP of greater than 20 mm Hg or a drop in diastolic BP of greater than 10 mm Hg shortly after standing.

70
Q

Hx for falls

A 
Previous falls or fractures 
Hx of gait or balance problems 
Medications 
Detail SH incl mookilty aids, hazards home 
Hx of drug and alcohol 
DO they drive - relevant if syncope
71
Q

Medications that can cause falls

A 
Antihypertensives
Anticholinergics
Antipsychotics
Sedatives
Opiates
Antidepressants, Hypoglycaemics
72
Q

Examination for fallen pt

A 
Gait assemsnt 
Cardiovascular assessment
Neurological examination
Examination feet and joints 
Check vision 
Check cognition
73
Q

Cardiovascular assessment for fallen pt

A

Pulse rate and rhythm, lying and standing blood pressure (BP), and presence of cardiac murmurs.

74
Q

What are we looking for in a neurological examination for a fallen pt

A

Evidence of stroke, Parkinson’s disease, peripheral neuropathy, foot drop, cerebellar signs, and proprioception problems.

75
Q

Ix fir a fallen person

A

Bloods
ECG – arrythmia or cardiac disease
Lying and standing bp
Tilt table test for syncope

76
Q

Blood for a fallen person

A

Check for anaemia, hypoglycaemia, dehydration, infection, vitamin B12/ D deficiency

77
Q

Management after admission w/ a fall

A

Treat underlying medical causes and delirium
Treat postural hypotension
Medication review aiming for deprescribing
Ensure appropriate footwear
Gait and balance training by a pt
Environmental assessment by an OT
Consider use of pendant alarms, bed or chair sensors

78
Q

Fludrocortisone

A

Corticosteroid used for treating postural hypotension

79
Q

Fludrocortisone dosage

A

100mg – 400mg ODS

80
Q

When are individuals entitled to care and support

A

The adult has eligible needs
The adult is an ordinarily resident in the area (their home is established there) AND
Either people cannot afford to pay full costs, person doesn’t have mental capacity or have asked local authority to meet their needs

81
Q

Presentation of falls

A

Failure to cope
Found on floor
Delirium
Off feet

82
Q

Asking a pt what happened during a falls

A 
Incontinence or tongue biting 
Loss of consciousness 
Pt pale/ flushed 
Pt injured
What part of the body had the first contact with the floor?
83
Q

Aking a pt what happened after a fall

A

Ws the pt able to get up after
How long did it take them
Was the pt able to resume normal activities
Was there any weakness or speech difficulty

84
Q

Systems enquiry after a fall

A 
General 
Cardiovascular 
Respiratory 
Neurological 
Genitourinary 
GI 
MSK
85
Q

General system enquiry after a fall

A

Fatigue
Wt loss

PMH - visual/ hearing impairment, DM, anaemia

86
Q

Cardiovascular system enquiry after a fall

A

Chest pain
Palpitations

PMH - cardiovascular disease, arrhythmias

87
Q

Respiratory system enquiry after a fall

A

SOB
Cough

PMH - COPD

88
Q

Neurological system enquiry after a fall

A

Loss of consciousness
Seizures
Motor or sensory disturbance

PMH - Parkinson’s, peripheral neuropathy, stroke, dementia

89
Q

GU system enquiry after a fall

A

Incontinence
Urgency
Dysuria

PMH - recurrent UTI, incontinence

90
Q

GI system enquiry after a fall

A

Abdominal pain
Diarrhoea
Constipation

PMH - Diverticulitis, chronic diarrhoea, alcoholic liver disease

91
Q

MSK system enquiry after a fall

A

Joint pain
Muscle weakness

PMH - arthritis, chronic pain, fractures

92
Q

Home safety assessment

A

Assessment of commonly used areas inside and outside the home
Observation of the older person moving around the home environment
Fall risk and health status of the older person

93
Q

Which types of problems are identified by home safety checklists

A

Hazards
Problem areas
Lack of supportive or safety features

94
Q

Different locations care can be provided

A 
Hospital
Hospice
Nursing home 
Residential home 
Home
95
Q

Syncope

A

Fainting

96
Q

What are syncopal episodes triggered by

A

A sudden, temporary drop in blood flow to the brain, which leads to loss of consciousness and muscle control

97
Q

Falls and poor nutrition

A

Deficiencies in protein, vit D, calcium, vit B12 and folic acid
Dehydration

MBBS - Year 1 (93 decks)

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