Falls Flashcards
intrinsic factors leading to falls
age related changes in gait and muscle strength, reflexes acute illness diabetes arthritis parkinsons stroke cognition incontinence impaired vision or hearing fear of falling
extrinsic medications that may increase falls risks
diuretics antihypertensives sedatives anticholinergics hypoglycaemics
extrinsic environmental factors that may increase falls risk
stairs rug furniture inadequate lighting inappropriate footwear inappropriate walking aids
how can diabetes increase falls risk
diabetic retinopathy may lead to poorer vision
diabetic neuropathy may lead to altered proprioception
how can incontinence lead to increase in falls risk
rush to toilet esp night
how can fear of falling lead to increase in falls risk
paradoxical increase in risk due to cautious gait
what % of those with cognitive impairment suffer falls
80%
do a 4AT ± MOCA/MMSE
true/false - antidepressants increase falls risk
true
what antidepressants and antipsychotics can lead to orthostatic hypotension
venlafaxine
duloxetine
risperidone
haloperidol
what anticonvulsant may lead to permanent cerebellar damage and ataxia in toxic levels in the blood
phenytoin
systolic BP of ___ leads to increase falls risk
<110 mmHg
what antihypertensives increase risk of falls, what cardiac medicines have a survival benefit
alpha blockers - prostatism
nitrates, CCB
survival benefit in ACEI and BB
what aspects of gait should be examined in an elderly patient who has suspected disturbance
joint swelling muscle wasting shortening/foot drop peripheral neuropathy abnormalities of the feet assess gait/rombergs
what is the most common neurological condition leading to ataxia in the elderly
peripheral neuropathy
possible causes of peripheral neuropathy
diabetes
B12 deficiency
hypothyroid
when is peripheral neuropathy functionally significant in falls patients
lost heel reflexes
decreased vibration improving proximal
imapired position sense at great toe
cannot maintain unipedal stance for 10s in 3 attempts
management of peripheral neuropathy in falls pts
correct walking aid use
decent shoes and orthotics
balance and strength exercise
causes of orthostatic hypotension
decreased autonomic buffering due to age volume depletion prolonged bed rest alpha blockers or diuretics neurogenic orthostatic hypotension arrhythmia carotid sinus sensitivity seizure
what may cause neurogenic orthostatic hypotension
diabetes
amyloidosis
DLB
parkinsons disease
conservative management of orthostatic hypotension
stop possible drugs avoid sudden movement change water load increase salt compression stockings elevate legs calf muscle exercises when standing for long periods
medical management of orthostatic hypotension
fludrocortisone
midodrine
what is a drop attack
sudden collapse with no preceding symptoms and without apparent LOC
aspects of history to ask in falls?
where did it occur preceding/during/after any LOC any injury or head injury could you get up how long lying past falls was it different fear of falling
examinations to conduct in falls?
observations injuries - head, pelvis, hip, vertebrae cardiac - BP, murmur neuro - vision, peripheral neuropathy, gait, stroke 4AMT ±MOCA/MMSE HINTS dix hallpike
investigations to conduct in falls?
ECG ± telemetry blood glucose postural BP timed up and go consider echo CT head ambulatory ECG tilt table test carotid sinus massage inflammatory markers and U&E
when is an urgent plain head CT indicated
GCS <13 GCS< 15 after 2 hours injury suspected depressed or open skull fracture suspected basal skull fracture post traumatic seizure new focal neuro >2 episodes vomiting
when is a plain head CT indicated within 8 hours
LOC or amnesia since injury and >65, or >30 mins retrograde amnesia, or on anticoagulation, or dangerous injury mechanism
signs of a base of skull fracture?
haemotympanum
panda eyes
battles sign
CSF leak from nose or ears
HTN target for >80yrs
<150/90
what is carotid sinus syndrome
abnormal activation of carotid sinus baroreceptors leading to peripheral vasodilation and reduced HR, leading to cerebral hypoperfusion
positive findings on carotid sinus massage suggesting CSS
cardioinhibition - paused HR >3s
vasopressor - drop in SBP 50mmHg
or both
contraindication to carotid sinus massage
MI/CVA in 3m
Hx VT
carotid artery stenosis
risks associated with carotid sinus massage
stroke or TIA
