Falls Flashcards
What is THE ‘buzzword’ when discussing the aetiology of falls?
‘MULTIFACTORIAL’
List some of the physiological causes of falls in elderly people?
- Reduced visual acuity
- Reduced righting reflexes + reduced balance
- Diminished muscle strength/deconditioning
- Reduced joint mobility – arthritic conditions
- Impaired sensory systems
- Problems within the CVS system
- Neurological disease or degeneration
- Cognitive decline
What do NICE ask of clinicians with regards to falls and elderly patients?
Older people in contact with healthcare professionals should be asked routinely whether they have
fallen in the past year and asked about the frequency, context and characteristics of the fall/s.
What should be evaluated in a multifactorial falls risk assessment?
- identification of falls history
- assessment of gait, balance and mobility, and muscle weakness
- assessment of osteoporosis risk
- assessment of the older person’s perceived functional ability and fear relating to falling
- assessment of visual impairment
- assessment of cognitive impairment and neurological examination
- assessment of urinary incontinence
- assessment of home hazards
- cardiovascular examination and medication review
What injuries are often seen alongside falls?
- Fracture (#) – wrist, hip, pelvis, humerus or vertebrae
- Head injury
- Laceration
- Bleeding
- Bruising
- LOC
What risks are associated with falls + long lie (>2 hours)?
- Dehydration
- Pressure ulcers
- Rhabdomyolysis
- Hypothermia
- Pneumonia
- Delirium
What are the consequences of falls?
- Injury – #, brain injury, lacerations & bruising
- Death – 5% hip # die in hospital and up to 1/3 die within 1 year
- 50% hip # do not regain baseline mobility
- Many decide to go into care homes
- Loss of confidence
- House bound
- Reduced activities and quality of life
How are falls managed?
- Initial focus on the injury & healing
- Rehabilitation
- Improve mobility, confidence & safety
- Prevention & support
- Multidisciplinary team input
- Bone health
- Falls education & exercise classes
Outline the multifactorial nature of falls by listing risk factors.
- MEDICATIONS
- Medical conditions
- Gait and balance impairment
- Visual and hearing impairment
- Cognitive impairment and confusion
- Muscle weakness
- Inadequate diet and exercise
- Alcohol
- Risk taking behaviours
- Environmental hazards
- Female
- Age > 80 years
Outline sensory system changes with age relating to postural control and balance.
- Vision:
• Reduced VA
• Reduced depth perception
• Reduced contrast sensitivity - Vestibular system changes causing
• Unsteadiness
• Dizziness - Reduced vibration & proprioception sensation
What are some significant age-related changes which contribute to falls?
• Known loss of cilia in semicircular canals, utricle and
saccule of vestibular system
• Progressive decline in baroreceptor function
• Resting cerebral blood flow close to threshold for cerebral ischemia (loss of cerebral automaticity)
Outline examples of psychotropic (drugs that act on the brain) drugs which can cause falls.
- Benzodiazepines (drowsiness, slow reactions, impaired balance)
- “Z” drugs e.g. zopiclone/zolpidem (“ “)
- Tricyclic antidepressants (sedating) - e.g. amitriptyline (alpha blocking ability = orthostatic hypotension + can cause drowsiness and slow reaction times)
- MAOIs (rarely used now) - e.g. phenelzine - severe orthostatic hypotension
- Drugs for psychosis/agitation e.g. chlorpromazine, haloperidol, risperidone, quetiapine, olanzapine (all have alpha-receptor blocking activity)
- SNRIs e.g. venlafaxine, duloxetine (orthostatic hypotension through noradrenaline reuptake blockade)
- Opiate analgesias (codeine, tramadol, morphine) - sedation, slow reactions, impair balance, delirium
- Anti-epileptics (phenytoin, carbamazepine) - phenytoin can cause irreversible cerebellar damage/both drugs cause ataxia when blood levels too high
- MAOI-B inhibitors for Parkinson’s disease e.g. ropinirole, selegiline - orthostatic hypotension + delirium
Outline examples of drugs which affect the heart and circulation in precipitating falls.
- Alpha-receptor blockers e.g. Doxazosin, prazosin,
tamsulosin, alfluzosin - used for HTN + prostatism - commonly cause severe orthostatic hypotension
NB/stopping them may precipitate urinary retention in men - Thiazide diuretics e.g. Bendroflumethiazide,
chlorthalidone, metolazone - orthostatic hypotension + muscle weakness (low K+) and hyponatraemia - ACEi e.g. ramipril, lisinopril, enalapril - rely almost entirely on kidney for excretion and can build in dehydration
- Beta-blockers e.g. atenolol, sotalol - bradycardia, hypotension, carotid sinus hypersensitivity, orthostatic hypotension and vasovagal syndrome
- Anti-anginals e.g. GTN, isosorbide mononitrate, nicorandil - can cause syncope due to sudden drop of BP (GNT) and hypotension/paroxysmal hypotension
List some anti-cholinergic drugs and briefly explain their role in precipitating falls.
E.g. Benzhexol, Procyclidine, Oxybutinin, Tolterodine
- Used to treat tremors and urinary incontinence
- May lead to confusion and ‘mental fuzziness’ in elderly
Outline the medications used to reduce the risk of a fragility fracture.
- Bisphosphonates (alendronate/risedronate/strontium)
- Calcium and vitamin D (adcal D3/calcichew D3/calfovit D3)
Outline the management of fragility fractures
