Elderly - immobility and falls

Question 1

Falls - briefly describe meaning

Answer 1

inadvertently coming to rest on floor
no loss of consciousness
not due to alcohol, paralysis, epileptic seizure or force

Question 2

Outcomes after a fall

Answer 2

carer stress and institutionalisation 
injury - soft tissue, fracture, subdural 
loss of confidence 
rhabdomyolysis 
dependency/reduced QOL
terminal decline 
inability to cope

Question 3

Risk factors for falls

Answer 3

muscle weakness - gait deficit - vision - over 80 - arthritis - depression - reduced cognition

Question 4

Intrinsic factors of falls

Answer 4

gait and balance 
syncope 
chronic conditions - CNS and MSK 
visual problems 
acute illness 
Vit D deficiency 
cognitive disorders

Question 5

Situational factors of falls

Answer 5

medications eg antidepressants, antimuscarinics, anti hypertensives, diuretics
alcohol
urgency of micturition

Question 6

Extrinsic factors of falls

Answer 6

inappropriate footwear
environmental eg stairs, walking aids, carpets
poor lighting

Question 7

Gait and balance assessment

Answer 7

standing to sitting 
static standing balance 
Romberg test 
get up and go timed test 
gait
dynamic standing balance - functional reach, tandem walk and timed walk

Question 8

Vertigo causes

Answer 8

inner ear infection, labyrinthitis, BPPV, cerebellar/brainstem pathology

Question 9

5 types of syncope

Answer 9

neutrally mediated 
orthostatic hypotension 
cardiac arrhythmias 
structural cardiac or cardiopulmonary disease 
cerebrovascular

Question 10

Syncope history and exam

Answer 10

history from patient and collateral history
12 lead ECG
red flags?
sitting and standing bp

Question 11

red flags of syncope

Answer 11

ECG abnormal, FH of sudden death, heart failure, onset with exertion, new or unexplained SOB, heart murmur

Question 12

Test to do if suspected carotid sinus sensitivity

Answer 12

carotid sinus massage

Question 13

Things that would make you suspect a seizure

Answer 13

prolonged limb jerk, confusion, head turning, bitten tongue, no memory, unusual posture

Question 14

Cognitive disorders

Answer 14

dementia - impairs ability to perceive and avoid hazards, judgement, gait and visual perception
delirium and depression

Question 15

Osteoporosis

Answer 15

FRAX or QFRACTURE tool
BMD using DEXA
Calcium, vit D supplements and bisphosphonates

Question 16

Sarcopenia mnemonic

Answer 16

Diabetes/insulin resistance
Elderly
Chronic disease
Lack of use
Inflammation 
Nutritional deficiency 
Endocrine dysfunction

Question 17

sarcopenia

Answer 17

degenerative loss of muscle mass

Question 18

physical complications of immobility

Answer 18

muscle wasting, muscle contractures, pressure sores, DVT, constipation, hypothermia, osteoporosis

Question 19

psychological and social complications of immobility

Answer 19

depression, loss of confidence, isolation and institutionalisation