Elderly Falls Flashcards
Define a fall
Inadvertently coming to rest on ground/lower level WITHOUT loss of consciousness and other than as a consequence of sudden paralysis, seizure, alcohol or overwhelming physical force
What are the risk factors for a fall?
H/o
Muscle weakness
Gait or balance deficit
Use of assistive device
Visual deficit
Arthritis
Depression or cognitive impairment
>80yrs
What intrinsic factors (aka disorders) could cause a fall?
Chronic neuro/MSK disease
Visual problems
Acute illness e.g. UTI, chest infection
Cognitive disorders e.g. dementia or delirium
Syncope
Gait/balance problems
simply Postural Instability is the biggest cause of falls in the elderly, how would we asses a patient’s gait and balance to see if they’re at risk of such a fall?
Sit -> Stand ability
Static standing balance & Romberg test
Dynamic standing balance
Gait
Berg balance scale
Timed get up and go test (TUG)
What is a TUG test?
Timed get Up and Go (TUG)
The patient is timed for how long it takes them to stand from a chair, walk 10 feet then come back and sit down
Other than Postural Instability, can you think of another balance issue that would cause a lot of falls in the elderly?
Vertigo! Particularly BPPV
Think of possible causes for syncope
- Vasovagal
- Carotid sinus hypersensitivity
- Situational
- Orthostatic hypotension
- Cardiac arrythmias
- Structural cardiopulm disease
- Cerebrovascular events
Thinking about the elderly, what could cause “Situational” syncope?
Some people get it post-micturition, post-exercise or on defecation
What are the most common causes of orthostatic hypotension?
Drug (prescribed) induced autonomic failure
Volume depletion due to haemorrhage or diarrhoea
Think of some structural cardiac or cardiopulm disorders that could cause syncope?
Acute MI
PE
Valvular disease
Someone has an episode of syncope, what would you want to know?
- Any prodromal symptoms?
- Loss of consciousness? Last & first things they recall
- H/o
- Injuries
- PMH & FH
- Meds
- 3rd party (appearance, movements, tongue-biting, duration and confusion/weakness in recovery)
How would you examine someone who’s had syncope?
Standing & lying BP
NEuro & CV exam
look for injuries
Also do an ECG
When assessing a patient with syncope what would be red-flag symptoms?
- Certain ECG abnormalities
- Heart failure symptoms/signs
- Onset with exertion
- F/h sudden cardiac deathj
- New/unexplained SOB
- Murmur
What signs would suggest syncope might actually have been a seizure?
Bitten tongue
Head turning to one side
Abnormal behaviour with no memory
Unusual posture
Prolonged jerking
Confusion afterward
Prodromal Deja vu
We’ve covered intrinsic factors contributing to falls. What situational factors could trigger a fall?
- Some meds e.g. antidepressants, anti-hypertensives, anti-muscarinics and diuretics
- Alcohol
- Urgency to micturate
