Falls Flashcards
Usual causes of falls in the elderly?
Bad flooring
Bad lighting
Medications
Alcohol
What main 3 overarching classes of drugs can increase fall risk?
Psychotropic medication
Cardiovascular medication
Pain medication
Name 5 psychotropic medication types that can increase fall risk?
Antidepressants anxiolytics Hypnotics Sedatives Anticonvulsants
Name 7 cardiovascular medication types that increase fall risk?
Alpha blockers Beta blockers ACE inhibitors Calcium channel blockers Diuretics Anti hypertensives Nitrates
6 causes of fainting or LOC spontaneous falls in elderly?
Vasovagal response Blood loss Medication Cardiac disease Blood complication - electrolytes, glucose, oxygen/co2, Intrinsic brain disease
What is stimulated in a vasovagal faint?
nucleus tractus solitarii
What are debility related falls described as?
Premonitory falls of old age
3 main causes of spontaneous falls in elderly?
LOC/fainting
Diffuse brain injury
debility
If the patient falls whilst moving what are 7 different causes related to different types of movement?
Standing up - postural hypotension
Exertion - aortic stenosis, pulmonary hypertension or pulmonary stenosis
Carotid sinus hypersensitivity
Moving the arm - subclavian steal syndrome
Coughing syncope
Micturition syncope
Turning - vertebro-basilar ischaemia
What locomotor disorders can cause falls in elderly?
OA
Parkinsons
Stroke
Peripheral neuropathy
Besides fainting and locomotor disorders what another big reason of falls in elderly on movement?
Visual impairment
What happens in vertebrobasilar ischaemia and what does it lead to?
there is reduced blood supply through the vertebral arteries which causes ischaemia of the brain stem and therefore leads to drop attacks
What is the main cause of recurrent drop attacks?
Vetebro-basiliar ischaemia
Why does turning the head cause vertebrobasiliar ischaemia? What is it a disease of?
Kinks the vertebral arteries as they pass through the foreman
Disease of the cervical vertebrae or intervertebral joints
What kind of physical limitation is often found in people who suffer with vertebrobasilar ischaemia?
Head rotation limitation
Pain on moving neck
4 main causes of postural hypotension?
antihypertensive medication, hyponatraemia caused by diuretics usually, autonomic neuropathy (diabetics), sympathectomy
What difference in blood pressure is needed lying to standing in order to diagnose postural hypotension?
20mmHg or more
What medication can be used to treat autonomic neuropathy related postural hypotension?
Fludrocortisone - increase sodium
What happens in cough and micturition syncope that leads to fainting?
Increase in intrathoracic pressure
valsalva manouvre
drop in BP
difference between epilepsy and syncope?
Epilepsy has tonic clonic seizures, takes longer to recover from, proceded by an aura and sudden onset, no change in colour, UI, tongue biting, transient hemiplegia
Most are 3 reasons for new onset epilepsy in the elderly?
Cerebrovascular disease
Dementia
Tumours
How can you investigate and establish whether someone has epilepsy or syncope?
EEG
What is Todd’s paralysis?
After a seizure can experience focal weakness in a part of the body after a seizure, appendages most effected, localised
What is carotid sinus hypersensitivity?
Sensitivity of the carotid sinus baroreceptors that leads to transient diminished cerebral perfusion
How do you diagnose carotid sinus hypersensitivity and what 2 things does a positive result show?
Carotid sinus massage
Cardio inhibition - 3 seconds asystole
Vasodepression - BP drops by 50mmHg
Combination
4 things that carotid sinus hypersensitivity is associated with?
Hypertension
IHD
Lewy body dementia
Medications
If someone complains of dizziness what 2 things do you need to distinguish between?
Whether the dizziness is caused by vertigo or if it is light headedness caused by issues in multiple sensory inputs
How long does BPPV attack last for?
around 30 seconds
What are the crystals called that get dislodged in BPPV?
otoliths
2 situations where someone is more predisposed to developing BPPV?
Previous head trauma or vestibular necrosis
What is the test for BPPV and what is the treatment?
Dix hallpike test
Epley Manoeuvre
What is considered a long lie after a fall?
over 2 hours
With a long lie after a fall what are 6 risk factors that could potentially develop?
dehydration pneumonia pressure sores rhabdomyolysis hypothermia delirium
When taking a history of a fall what 12 things do you need to ask about in the history?
Cognition Gait and balance Sensory loss Sleep Continence Footwear and footcare Osteoporosis risk factors Dizziness/syncope Medication Previous falls and injury SH Assess home hazards
How do you assess gait and balance?
length of step and foot lifting Use of walking aids? Speed of walking Time up and go BERG balance test
What is the BERG balance test?
It is a 56 point scoring system with 14 activities rated 0-4 on ability to complete them
3 steps in management of a fall in the elderly?
Fix the injury
rehabilitation
Falls service
What do the Falls service do?
They provide education on falls
Prevent repeat falls
Bone health
7 ways we can prevent falls in the elderly?
Education (Falls service) Review medications Provide better lighting Alarms regular eye checks Elastic stockings for those with varicose veins or leg oedema Footwear
Parkinson like symptoms that are often common in the elderly? 3 differentials?
Rigidity
Apraxia of gait
Wide based gait
Poverty of movement
Increased muscle tone - cogwheel character
Differentials include ministrokes, normal pressure hydrocephalus, dementia
what is normal pressure hydrocephalus and what are the triad of symptoms?
When there is abnormal levels of CSF production causing ventriculomegaly but adapts to a higher normal of 150 to 200 mm H20
ICP isnt elevated
Symptoms arent classic
triad- UI, mental impairment, walking difficulties
What is the gait usually like in normal pressure hydrocephalus?
Apraxic gait
Spasticity
Bilateral extensor plantar responses
How do you diagnosis normal pressure hydrocephalus?
CT
Dilated ventricles
ICP is usually normal
Treatment of normal pressure hydocephalus?
Ventriculoperitoneal shunt or ventriculoatrial shunt
Rehabilitation
