Falls Flashcards
Define a “fall” and a “loss of balance”
Loss of balance:
* Unsteadiness when sitting, standing, or walking that may result in a fall.
Fall:
* “an event that results in the individual coming to rest inadvertently on the ground or floor or other lower
surface”
Describe the epidemiology of falls in Australia and their significance
Falls related deaths are the 6th most common cause of death amongst elderly population
* 75% of people who die from a fall are over the age of 65
* 20% of falls for elderly result in hip fractures
* Falls account for 90% of fractures in elderly
* Projecting cost for healthcare system
Explain the cyclical nature of the fear of falling.
Fall -> loss of confidence -> less physical activity/social -> balance and walking deteriorate -> risk of fall increase.
- Decreases independence, Carer burden, change care level
What are some common differential diagnosis associated with traumatic causes of a loss of balance, dizziness or falls that need to ruled out?
BPPV
Traumatic brain injury
What is a common differential diagnosis associated with metabolic causes of a loss of balance, dizziness or falls that need to ruled out?
Diabetic neuropathy
What are some common differential diagnosis associated with vascular causes of a loss of balance, dizziness or falls that need to ruled out?
- CVA
- orthostatic/postural hypotension
What are some rare differential diagnosis associated with vascular causes of a loss of balance, dizziness or falls that need to ruled out?
- vasculitis
- Walenberg’s syndrome
- VBAI
What is a common differential diagnosis associated with congenital causes of a loss of balance, dizziness or falls that need to ruled out?
Hydrocephalus
What is a common differential diagnosis associated with neurogenic/pyschologenic causes of a loss of balance, dizziness or falls that need to ruled out?
Peripheral neuropathy
What is an uncommon differential diagnosis associated with neurogenic/pyschologienic causes of a loss of balance, dizziness or falls that need to ruled out?
meniere’s disease
List the most common intrinsic risk factors that are associated with falls.
- Previous falls
- Balance
- Mobility
Examples of poor footwear which increases the risk for an elderly persons to fall
Poor fitting
lack of fixation
high heels
slippers
socks
Good footwear includes
- thin soles (foot position)
- low square heel (balance)
- supportive collar (balance)
what tests would you perform for vertigo, or other balance disorders?
Berg balance scale & TUG test
If you decide your patient does not need a referrel and hasn’t sustrained a fracture, what questions would you ask?
“SPLAT”
- Symptoms associated
- Prior falls
- Location of the fall
- Activity at the time
- Time of day
- Trauma (physical, psychological)
What medication is important to consider for osteoporosis?
HRT- hormone replacement therapy
Lifestyle changes for osteoporosis
Nutrition
Calcium + vit D
No smoking , alcohol
Weight bearing exercises
What is the Mc cause of dizziness and vertigo?
BPPV (Benign paroxysmal positional vertigo)
In older pople with cognitive impairment, what has been found to be associated with increase risk falls?
- Confusion
- Disorientation
- Dementia
Confusion, disorientation, and dementia have all
been found to be associated with falls. What are some other risk factors for falls which are more prevalent in older people with cognitive impairment
- Gait and balance
- Psycoactive drugs prescribed
- Orthostatic hypotension
How to manage the health status of olderly patients to minimize the risk of falls
- Physical activity
- Environmental hazards
- Hydration and nutrition
- Osteoporosis Ax/Mx
- Medications (where possible)
Differential diagnosis: Common Traumatic causes for loss of balance and falls
BBPV
Traumatic brain injury
Uncommon Inflammatory cause for loss of balance and falls
Aseptic: : Multiple sclerosis (MS)
Differential diagnosis: Common congenital causes for loss of balance and falls
Hydrocephalus
Differential diagnosis: Common neurogenic/pyschogenic causes for loss of balance and falls
Peripheral Neuropathy
Differential diagnosis: uncommon neurogenic/pyschogenic cause for loss of balance and falls
Meniere’s disease
Differential diagnosis: Common metabolic causes for loss of balance and falls
Diabetic neuropathy
Differential diagnosis: Common vascular causes for loss of balance and falls
CVA
Orthostatic hypotension (postural hypotension)
History taking questions for a elderly patient who has had previous falls
- Falls or near falls?
- Where?
- What happened immeditaly preceding fall?
- Was it witnessed?
- Were you able to get up after?
- Environment - slip, trip
- Other factors such as lighting, rushing, footwear, walking aids
Picture of SHOE that has good support
Supportive collar
Low heel
Beveled heel
Buckle mechanism
Firm mid sole
Slip resistant sole
