Evaluation and Management of Falls Flashcards
What are the key components of a fall screening for older adults?
Three key questions:
- feeling unsteady
- fear of falling
- past falls
(if yes, including frequency and injury)
What does the 12-Point STEADI Fall Screen include?
12-Point STEADI Fall Screen, including questions about feeling unsteady, fear of falling, and past falls.
What assessments are included in the STEADI Fall Screening?
- TUG
- CTSIB
- 30-second sit to stand
- 4-stage balance test
How many deaths and ED visits were caused by falls in 2019?
34,000 deaths and 3 million ED visits.
What are the four underlying causes of falls?
- Biomedical
- Physiological
- Psychosocial
- Environmental factors
What are the common results of falls according to APTA Geriatrics?
- hip fracture (37.9%)
- functional decline (20.6%)
- loss of autonomy (13.7%)
- depression (10.3%)
- UE injuries (5.7%).
How do falls affect Life Space scores?
Falls lead to a decrease in Life Space scores, with greater decline for falls with injury or fracture.
What percentage of older adults experience participation restriction?
More than 50%.
What factors are associated with fear of falling?
- use of assistive devices
- balance impairment
- depression
- trait anxiety
- female gender
- previous falls
What are intrinsic risk factors for falls?
- dizziness
- weakness
- gait abnormalities
- poor balance
- confusion
- poor coordination
- ROM
- cognitive impairment
What are extrinsic risk factors for falls?
- floor surface
- poor lighting
- cluttered furniture
- obstacles
- non-level surfaces
- poor shoes
What are the sensory system changes with aging?
Decreased vision acuity, contrast sensitivity, depth perception, vestibular changes, decreased proprioception, and vibration.
How does the somatosensory system contribute to postural control?
It provides information about body position with reference to supporting surfaces through muscle spindles, joint receptors, tendon organs, and mechanoreceptors.
What are common visual pathologies affecting the elderly?
Cataracts, diabetic retinopathy, glaucoma, macular degeneration.
How does aging affect the neuromuscular system?
- decreased muscle strength, ROM, flexibility, and increased stiffness of connective tissue.
What are the typical gait changes in older adults?
Decreased gait speed, step/stride length, increased stance time, double-limb support time, and increased variability of gait.
What are the gait ROM requirements for older adults?
- Hip: 30° flexion to 10° extension
- Knee: 0° to 60° flexion
- Ankle: 20° plantarflexion to 10° dorsiflexion
What does a score of 13 seconds or higher on the Five Times Sit to Stand Test indicate?
A modest ability to predict fall risk.
How does aging affect central processing?
- slowing of sensory information, nerve conduction velocity
- increased postural sway, co-contractions, and proximal-to-distal control for balance
What is Limits of Stability (LOS)?
The maximum angle from vertical that can be tolerated without losing balance.
What are the three major movement strategies in reactive control?
- Reactive control (corrective or protective), anticipatory postural control, perturbated movement strategies (hip, ankle, knee, and step)
- Ankle Strategy: This is used for small perturbations and slow-speed movements. The body maintains balance primarily through movements at the ankle joint. This strategy is most effective on firm surfaces.
- Hip Strategy: This is utilized for larger, faster perturbations or when standing on a compliant or narrow surface. The body maintains balance through larger movements at the hip joint to shift the center of mass over the base of support.
- Stepping Strategy: This strategy is employed when perturbations are large enough that the previous two strategies are insufficient to maintain balance. The individual takes a step or makes a movement to widen the base of support and realign the center of mass within this new base.
What are some validated tools to assess gait and balance?
- FGA
- DGI
- Tinetti
What does the Functional Performance Test assess?
Chair rise performance to predict fall risk
- 5 time sit to stand
- consider balance tests
How is proprioception tested in the sensory system?
- Sense of position and sense of movement
- Starting distally and moving proximally if deficits are noted
- Toe up/down test with eyes closed
What are common sensory changes to consider in fall evaluations?
Changes in…
- smell
- vision
- hearing
- taste
- touch
- somatosensory inputs
What does postural assessment in neuromuscular testing include?
General postural assessment, position of head, shoulders, thoracic/lumbar spine, and lateral lean.
How do you evaluate muscle strength in older adults?
Through Manual Muscle Testing (MMT) and observing functional movements like sit to stand.
What are key environmental modifications to prevent falls?
- Ramp specifications
- doorway width
- threshold height
- carpet pile
- hallway width
- wheelchair turning space
- bathroom sink/toilet specifications
What are psychosocial factors contributing to falls?
- social support
- safe environment
- cognitive function
- depression
- dementia
What is the role of the Falls Efficacy Scale (FES)?
- Measures fear of falling and associated confidence in performing activities.
- > 70 = fear of falling
How do you perform the Activities-Specific Balance Confidence (ABC) Scale?
Rate confidence for performing activities on a scale from 0 (no confidence) to 100 (complete confidence).
What is the Manual Test of Postural Perturbation?
Therapist pulls patient at waist level with varying degrees of force to examine postural control.
What signs and symptoms in the medical record might lead you to test central processing?
Slowing of sensory information, increased postural sway, and co-contractions.
What are good resources for fall prevention?
Fall CPG from Registered Nursing Association of Ontario, APTA Geriatrics Fall Prevention Awareness Toolkit.
What are common extrinsic factors that contribute to falls?
Environmental factors such as floor surface, lighting, furniture, obstacles, and footwear.
What causes an even greater decline in life space scores after a fall?
- Fall & injury
- fall & fracture
- fall & hip fracture
These are all major reasons that cause an even greater decline in life space scores
What are the four types of falls?
- Grade 1: near fall –> slip, trip, or loss of balance
- Grade 2: Fall –> fell to the ground or a lower level, but did NOT receive medical attention
- Grade 3: Fall –> fell to the ground or a lower level, but they received medical attention
- Grade 4: Fall –> fell to the ground or a lower level and had to stay in the hospital
What neuromuscular test outcomes could be related to risk of falls?
- toe flexor strength
- ankle ROM
- severe hallux valgus
