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?
1- CVS • Postural hypotension • Arrythmia • Heart failure • Aortic Stenosis
2- Sensory
• Visual impairment
• Inattention
• (Hearing)
3- Neurological • Stroke, old or new • Parkinsonism • Dementia • Delirium, Ataxia (Seizure, TIA)
4- Drugs 5- MSK • Arthritis of weight bearing joints • Sarocopenia • Deformities of feet
6- Incontinence: rushing to the toilet
7- Being generally unwell
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
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
What extrinsic factors contribute to falls?
Footwear
Poor lighting
Unfamiliar environments
Environmental hazards like uneven paving or stairs
A major danger for elderly people at risk of falls is fractures, particularly with Osteoporosis. How do we screen for osteoporosis?
FRAX or QFRACTURE tools to assess risk.
If fracture risk is >10% at 10yrs we test BMD using DEXA scanning
