Clinical skills - Old Age & Falls Flashcards

Question

Parietal lobe function

Answer 1

Spatial awareness

Answer 2

Visual perception

Answer 3

Timing cues for automatic movement | Postural reflexes

Answer 4

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

Answer 5

Stretch reflex | Crossed extensor reflex

Answer 6

Maintenance of postural muscle tone | Righting reflexes

Answer 7

Reduced acuity Reduced contrast sensitivity Reduced dark adaptation

Answer 8

Reduced proprioception | Reduced touch sensitivity in the foot

Answer 9

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

Answer 10

Reduced muscle mass Reduced muscle strength Slower contraction

Answer 11

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

Answer 12

``` 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 ```

Answer 13

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

Answer 14

A home hazard assessment and safety intervention/ medications

Answer 15

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

Answer 16

``` A+E OPED OPAC wards OPAS ```

Answer 17

Older peoples emergency department, undergoes comprehensive geriatric assessment

Answer 18

Older peoples assessment centre (nurse led discharge centre)

Answer 19

Older peoples assessment service (consultant-led outpatient service)

Answer 20

Over a 1/5

Answer 21

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

Answer 22

Almost 2/3

Answer 23

``` 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 ```

Answer 24

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

Answer 25

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

Answer 26

``` Deliriium Falls immobility - sudden change Continence problems Med management challenges ```

Answer 27

``` GP & nursing team Family Social care OT PT SLT ```

Answer 28

Prevent Hosp admission - crisi management

Answer 29

To prevent admission and set up immediate short term intervention plan

Answer 30

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

Answer 31

Factors affecting this are the environment, care delivery and risks

Answer 32

identifies occupational performance issues & implement plans to facilitate independece

Answer 33

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

Answer 34

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

Answer 35

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

Answer 36

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

Answer 37

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

Answer 38

Hyperactive, hypoactive or mixed with features of both

Answer 39

pt may have heightened arousal, agitation, aggression, restlessness

Answer 40

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

Answer 41

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

Answer 42

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

Answer 43

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.

Answer 44

``` 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 ```

Answer 45

``` Antihypertensives Anticholinergics Antipsychotics Sedatives Opiates Antidepressants, Hypoglycaemics ```

Answer 46

``` Gait assemsnt Cardiovascular assessment Neurological examination Examination feet and joints Check vision Check cognition ```

Answer 47

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

Answer 48

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

Answer 49

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

Answer 50

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

Answer 51

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

Answer 52

Corticosteroid used for treating postural hypotension

Answer 53

100mg – 400mg ODS

Answer 54

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

Answer 55

Failure to cope Found on floor Delirium Off feet

Answer 56

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

Answer 57

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

Answer 58

``` General Cardiovascular Respiratory Neurological Genitourinary GI MSK ```

Answer 59

Fatigue Wt loss PMH - visual/ hearing impairment, DM, anaemia

Answer 60

Chest pain Palpitations PMH - cardiovascular disease, arrhythmias

Answer 61

SOB Cough PMH - COPD

Answer 62

Loss of consciousness Seizures Motor or sensory disturbance PMH - Parkinson's, peripheral neuropathy, stroke, dementia

Answer 63

Incontinence Urgency Dysuria PMH - recurrent UTI, incontinence

Answer 64

Abdominal pain Diarrhoea Constipation PMH - Diverticulitis, chronic diarrhoea, alcoholic liver disease

Answer 65

Joint pain Muscle weakness PMH - arthritis, chronic pain, fractures

Answer 66

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

Answer 67

Hazards Problem areas Lack of supportive or safety features

Answer 68

``` Hospital Hospice Nursing home Residential home Home ```

Answer 69

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

Answer 70

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