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Geriatrics > Falls > Flashcards

Falls Flashcards

1
Q

Usual causes of falls in the elderly?

A

Bad flooring
Bad lighting
Medications
Alcohol

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2
Q

What main 3 overarching classes of drugs can increase fall risk?

A

Psychotropic medication
Cardiovascular medication
Pain medication

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3
Q

Name 5 psychotropic medication types that can increase fall risk?

A 
Antidepressants
anxiolytics
Hypnotics
Sedatives
Anticonvulsants
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4
Q

Name 7 cardiovascular medication types that increase fall risk?

A 
Alpha blockers
Beta blockers
ACE inhibitors 
Calcium channel blockers
Diuretics
Anti hypertensives 
Nitrates
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5
Q

6 causes of fainting or LOC spontaneous falls in elderly?

A 
Vasovagal response
Blood loss
Medication
Cardiac disease
Blood complication - electrolytes, glucose, oxygen/co2, 
Intrinsic brain disease
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6
Q

What is stimulated in a vasovagal faint?

A

nucleus tractus solitarii

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7
Q

What are debility related falls described as?

A

Premonitory falls of old age

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8
Q

3 main causes of spontaneous falls in elderly?

A

LOC/fainting
Diffuse brain injury
debility

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9
Q

If the patient falls whilst moving what are 7 different causes related to different types of movement?

A

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

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10
Q

What locomotor disorders can cause falls in elderly?

A

OA
Parkinsons
Stroke
Peripheral neuropathy

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11
Q

Besides fainting and locomotor disorders what another big reason of falls in elderly on movement?

A

Visual impairment

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12
Q

What happens in vertebrobasilar ischaemia and what does it lead to?

A

there is reduced blood supply through the vertebral arteries which causes ischaemia of the brain stem and therefore leads to drop attacks

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13
Q

What is the main cause of recurrent drop attacks?

A

Vetebro-basiliar ischaemia

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14
Q

Why does turning the head cause vertebrobasiliar ischaemia? What is it a disease of?

A

Kinks the vertebral arteries as they pass through the foreman
Disease of the cervical vertebrae or intervertebral joints

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15
Q

What kind of physical limitation is often found in people who suffer with vertebrobasilar ischaemia?

A

Head rotation limitation

Pain on moving neck

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16
Q

4 main causes of postural hypotension?

A

antihypertensive medication, hyponatraemia caused by diuretics usually, autonomic neuropathy (diabetics), sympathectomy

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17
Q

What difference in blood pressure is needed lying to standing in order to diagnose postural hypotension?

A

20mmHg or more

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18
Q

What medication can be used to treat autonomic neuropathy related postural hypotension?

A

Fludrocortisone - increase sodium

19
Q

What happens in cough and micturition syncope that leads to fainting?

A

Increase in intrathoracic pressure
valsalva manouvre
drop in BP

20
Q

difference between epilepsy and syncope?

A

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

21
Q

Most are 3 reasons for new onset epilepsy in the elderly?

A

Cerebrovascular disease
Dementia
Tumours

22
Q

How can you investigate and establish whether someone has epilepsy or syncope?

A

EEG

23
Q

What is Todd’s paralysis?

A

After a seizure can experience focal weakness in a part of the body after a seizure, appendages most effected, localised

24
Q

What is carotid sinus hypersensitivity?

A

Sensitivity of the carotid sinus baroreceptors that leads to transient diminished cerebral perfusion

25
Q

How do you diagnose carotid sinus hypersensitivity and what 2 things does a positive result show?

A

Carotid sinus massage
Cardio inhibition - 3 seconds asystole
Vasodepression - BP drops by 50mmHg
Combination

26
Q

4 things that carotid sinus hypersensitivity is associated with?

A

Hypertension
IHD
Lewy body dementia
Medications

27
Q

If someone complains of dizziness what 2 things do you need to distinguish between?

A

Whether the dizziness is caused by vertigo or if it is light headedness caused by issues in multiple sensory inputs

28
Q

How long does BPPV attack last for?

A

around 30 seconds

29
Q

What are the crystals called that get dislodged in BPPV?

A

otoliths

30
Q

2 situations where someone is more predisposed to developing BPPV?

A

Previous head trauma or vestibular necrosis

31
Q

What is the test for BPPV and what is the treatment?

A

Dix hallpike test

Epley Manoeuvre

32
Q

What is considered a long lie after a fall?

A

over 2 hours

33
Q

With a long lie after a fall what are 6 risk factors that could potentially develop?

A 
dehydration
pneumonia
pressure sores
rhabdomyolysis 
hypothermia 
delirium
34
Q

When taking a history of a fall what 12 things do you need to ask about in the history?

A 
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
35
Q

How do you assess gait and balance?

A 
length of step and foot lifting
Use of walking aids?
Speed of walking
Time up and go
BERG balance test
36
Q

What is the BERG balance test?

A

It is a 56 point scoring system with 14 activities rated 0-4 on ability to complete them

37
Q

3 steps in management of a fall in the elderly?

A

Fix the injury
rehabilitation
Falls service

38
Q

What do the Falls service do?

A

They provide education on falls
Prevent repeat falls
Bone health

39
Q

7 ways we can prevent falls in the elderly?

A 
Education (Falls service)
Review medications
Provide better lighting
Alarms
regular eye checks
Elastic stockings for those with varicose veins or leg oedema
Footwear
40
Q

Parkinson like symptoms that are often common in the elderly? 3 differentials?

A

Rigidity
Apraxia of gait
Wide based gait
Poverty of movement
Increased muscle tone - cogwheel character
Differentials include ministrokes, normal pressure hydrocephalus, dementia

41
Q

what is normal pressure hydrocephalus and what are the triad of symptoms?

A

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

42
Q

What is the gait usually like in normal pressure hydrocephalus?

A

Apraxic gait
Spasticity
Bilateral extensor plantar responses

43
Q

How do you diagnosis normal pressure hydrocephalus?

A

CT
Dilated ventricles
ICP is usually normal

44
Q

Treatment of normal pressure hydocephalus?

A

Ventriculoperitoneal shunt or ventriculoatrial shunt

Rehabilitation

Geriatrics (10 decks)

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