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Ageing and Complex Health > Falls > Flashcards

Falls Flashcards

1
Q

What should a falls hx include?

A
  • Cirumstances surrounding the fall, including preceding symptoms suggesting medical cause i.e. lightheadedness, vertigo, palpitations
  • Look for other potential causes, vision cognition and continence
  • Risk factors for osteoporosis
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2
Q

What are the drugs causes of falls?

A
  • Polypharmacy
  • Antihypertensives
  • Sedatives
  • Opioids
  • Psychotropics
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3
Q

What are the ageing related causes of falls?

A
  • Presbyopia
  • Cognitive decline
  • Gait abnormalities
  • Reduced postural sway
  • Reduced muscle mass
  • Slower reflexes
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4
Q

What are the medical causes of falls?

A
  • Cardiac - hypotension, arrhythmias
  • Neurological - Parkinson’s, stroke, myopathy
  • Osteoarthritis
  • Eye problems e.g. cataracts
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5
Q

What are the environmental causes of falls?

A
  • Walking aids
  • Footwear
  • Home hazards
  • Glasses - varifocals
  • Fear of falling
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6
Q

What do you want to ask about before the fall?

A
  • Where were they
  • What time of day was it
  • Is there a pattern to the falls
  • Did they have any symptoms before falling
  • Why do they think they fell
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7
Q

What do you want to ask about during the fall?

A
  • Did they lose consciousness

- Have they injured themselves

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8
Q

What do you want to ask about after the fall?

A
  • How did they get help
  • Were they able to get up
  • Have they suffered any complications i.e. long lie, fracture, head injury etc
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9
Q

What would a positive result of BP for postural hypotension?

A
  • Drop in >20mmHg systolic or more (with or without symptoms)
  • Drop to below 90mmHg on standing, even if drop is <20mmHg (with or without symptoms)
  • Drop in diastolic BP of >10mmHg with symptoms
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10
Q

What are the routine investigations for falls?

A
  • Blood glucose
  • ECG
  • Gait assessment
  • Lying and standing BP
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11
Q

What is vertigo?

A

Sensation of room spinning around, suggests problem is in vestibulo-labyrithine system.

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12
Q

What are the peripheral causes of vertigo?

A
  • BPPV
  • Meniere’s disease
  • Vestibular neuritis
  • Acoustic neuroma
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13
Q

What are the central causes of vertigo?

A
  • Migraine
  • Brainstem ischaemia
  • Cerebellar stroke
  • MS
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14
Q

What is BPPV?

A

Patients complain of short spells of vertigo (up to 1 min) that settle spontaneously. It occurs when they move their head (either getting in/out of bed, looking up or turning quickly). It can be diagnosed by the Dix-Hallpike manoeuvre and treated by the Epley maoeuvre.

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15
Q

What is pre-syncopal?

A
  • Feeling as if they are about to faint or complain of feeling lightheaded
  • Often when the patient is standing/seated/upright
  • Often associated with pallor/relieved by lying
  • Suggests cerebral hypoperfusion due to hypotension
  • Postural hypotension is a common cause of pre-syncopal symptoms in older patients
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16
Q

What does unsteady mean?

A

A general feeling of unsteadiness or feeling unbalanced that usually comes from a patients legs rather than their head.

17
Q

What are the psychogenic causes of falling?

A
  • Fear of falling
  • Loss of confidence
  • Anxiety/panic attacks/somatisation
  • Often associated and exacerbates organic dizziness
18
Q

What are the causes of transient loss of consciousness?

A
  • Uncomplicated faint or situational syncope
  • Orthostatic hypotension
  • Dysfunction of the nervous system (epilepsy)
  • Dysfunction of CV system (syncope)
  • Dysfunction of the psyche (psychogenic attacks)
19
Q

What are the investigations for TLoC?

A
  • Assess TLoC - details, medications, PMH, FH, general obs
  • ECG
  • EEG
20
Q

What do you examine for falls?

A
  • Neurological - upper and lower limb, cognition (AMT, CAM, MMSE)
  • Vision/vestibular
  • Cardiorespiratory (check peripheral oedema)
  • BP
  • MSK
21
Q

What investigations do you do for falls?

A
  • U+E’s (electrolyte abnormalities)
  • TFTs/B12/folate - potential causes of peripheral neuropathy
  • Vit D level
  • ECG - arrhythmias or other abnormalities
  • Bone profile - evidence of low or high calcium
  • FBC - anaemia and infection markers
  • CK - only if long lie for rhabdomyloysis
22
Q

What would results show for mild dehydration?

A
  • Mild hyponatraemia

- Raised urea

23
Q

What can increase the risk of falls?

A
  • Medication causing excess fluid loss and sedatives
  • Functional deterioration secondary to ageing - postural sway, decreased muscle tone/bulk, impaired sensory input
  • Urinary incontinence
24
Q

What is the management for falls?

A
  • Strength and balance training (exercise is one of the most effective)
  • Home hazard assessment and intervention
  • Vision assessment and referral
  • Medication review with modification/withdrawal
  • Manage co-morbidities e.g. diabetes, osteoporosis
25
Q

In osteoporosis when should the assessment of fracture risk be done?

A
  • Any person over the age of 50 with a hx of falls
  • All women over the age of 65
  • All men over 75
26
Q

What is the intervention for a low FRAX score?

A

Reassure, give lifestyle advice and reassess in 5 years or less depending on the clinical context.

27
Q

What is the intervention for an intermediate risk FRAX score?

A

Measure bone mineral density (BMD) and recalculate fracture risk to determine whether individuals’ risk less above or below intervention threshold.

28
Q

What is the intervention for a high risk FRAX score?

A

Can be considered for treatment without the need for BMD, although BMD measurement may sometimes be appropriate, particularly in younger menopausal women.

29
Q

When is BMD recommended?

A

If starting treatments that may have adverse effects on bone density AND if they have one of:

  • People <40 with major risk factor e.g. hx of multiple fragility, major osteoporotic fracture
  • Current or recent use of high dose oral/systemic glucocorticoids (>7.5mg prednisolone or equivalent per day for >/= 3 months)
30
Q

What is the 1st line treatment for osteoporosis?

A
  • Bisphosphonate (usually alendronic acid 70mg once weekly) and calcium and vitamin D supplements.
  • Vit D needs to be at 50 before starting bisphosphonates - 20,000 units 2x wkly for 6 wks then maintenance dose,
31
Q

What are age related changes related to falls?

A
  • Sarcopenia: ageing leads to decreased muscle mass due to multiple reasons such as hormonal loss, denervation atrophy and exacerbated by inactivity
  • Decreased BMD: increased risk of osteoporosis which can make falls more hazardous as increases risk of fractures
  • Decreased baroreceptor sensitivity: can potentiate postural hypotension
32
Q

What ageing related changes can cause postural instability?

A
  • Reaction time
  • Vision: visual acuity, contrast sensitivity
  • Vestibular function: visual field dependence
  • Peripheral sensation: tactile sensitivity, vibration sense, proprioception
  • Muscle force: knee flexion/extension, ankle dorsiflexion
33
Q

What changes in the cardiovascular system can make older people prone to falls and pre-syncope?

A
  • Reduction in baroreceptor sensitivity: usually compensates decreased BP with increasing HR. Can be exacerbated by BP/HR lowering drugs or HTN can damage baroreceptors.
  • RAS works less effectively: excessive salt wasting in kidneys > reduced blood volume - exacerbated by ACEi and diuretics
  • Left ventricular diastolic dysfunction: inability to increase SV effectively
  • Conduction system disease: SAN and AVN age through loss of pacemaker cells, generalised atrophy and amyloid deposits.
34
Q

What are the common causes of postural hypotension?

A
  • Drugs
  • Dehydration
  • Anaemia
  • Sepsis
  • Alcohol
  • Prolonged bed rest following illness
  • Adrenal insufficiency
35
Q

What drugs are linked to falls by causing postural hypotension?

A
  • Nitrates
  • ACEi
  • Diuretics
  • Anticholinergics
  • L-Dopa
  • Anti-platelet agents
  • Anti-depressants e.g. SSRIs
36
Q

What drugs are linked to falls via other mechanisms e.g. sedation/confusion/unsteadiness?

A
  • Benzodiazepines
  • Antipsychotics e.g. opiates
  • Codeine-based analgesics
  • Anticonvulsants
  • Digoxin
  • Class 1a anti-arrhythmics
37
Q

What helps with falls prevention?

A
  • Reduce deconditioning
  • Prevent delirium
  • Ensure call bell and walking aid are in reach
  • Ensure glasses and hearing aids are on
  • Correct footwear
  • Check lying/standing BP
  • Review medications
  • Review devices e.g. catheters, cannulas

Ageing and Complex Health (11 decks)

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