FALLS Flashcards
Prevalence of falls in the elderly population?
30% of those aged 65 and over have a fall at least once each year
50% in people aged 80 and over
Risk factors for falls?
History of falls
Conditions affecting mobility or balance - arthritis, diabetes, stroke, syncope, parkinsons etc
Conditions e.g. muscle weakness, visual impairment, alcohol misuse, poor balance
Fear of falling
Depression
Polypharmacy or drugs causing postural hypotension
Environmental hazards - loose rugs, mats, poor lighting, uneven surfaces, wet surfaces, loose fittings, poor footwear
Risk of having a second fall within 1 year of the first fall?
66%
Physiological changes of ageing that increase risk of falls?
Degradation of vestibular system
Proprioception
Eyesight
Sarcopenia
Decay of postural reflexes
Loss of autonomic reflexes
3 ways of categorizing falls?
Simple ‘one off’ falls
Recurrent falls
Syncope/presyncope
History of falls?
Was it witnessed
Before - what were they doing e.g. exercise, getting up, turning head, up from toilet? Do they remember falling or hitting the floor? Was there any warning signs e.g. chest pain or weakness? Have they felt well in days prior? Was there an obvious cause? Rule out possible seizure e.g. Aura
During - LOC? Seizure activity e.g. incontinence, tongue biting, muscle jerking? Head injury? Balance issues? Did they injure themselves?
After - how long were they on the floor? How did they get up? Post-ictal state? Amnesia?
PMHx - previous falls and other comorbidities
DHx - cause? Always ask about anticoags, steroids
Social
ICE
Assessment of a pt after a fall?
Examination of eyesight, lying and standing bp, 12 lead ECG
Obs, BG, urine dip
Bloods - FBC, U&Es, LFTs, bone profile
X-ray e.g. if concern of fracture
Physio - mobility and balance assessment, need for walking aids, Timed Up and Go test
OT - check home environment for any required adaptations, check need for equipment and assess ability to perform ADLs
What is the Timed Up and Go test?
Time the person getting up from a chair without using their arms, walking 3 metres, turning around, returning to the chair, and sitting down. If the person usually uses a walking aid, this can be used during the test.
During the test, observe the person’s postural stability, gait, stride length, and sway
A score of 12-15 seconds or more has been shown to indicate high risk of falls in older people
What is the Turn 180 test?
Ask the person to stand up and step around until they are facing the opposite direction
If they take more than 4 steps, further assessment should be considered
What is deconditioning syndrome?
condition of physiological, psychological and functional decline that occurs as a result of complex physical changes’, which happens with prolonged bed rest and the associated loss of muscle strength
Campaigns to raise awareness about deconditioning?
national Deconditioning Awareness and Prevention Campaign: Sit up, Get Dressed, Kepp Moving
Recondition the nation
Medications that can cause postural hypotension?
Nitrates
Diuretics
Anticholinergics
Antidepressants
Beta blockers
L-dopa
ACEi
Which patients should be given a multidisciplinary assessment by a qualified clinician regarding falls?
Pt over 65 with:
- >2 falls in the last 12 months
- A fall that requires medical treatment
- Poor performance or failure to complete the ‘Turn 180° test’ or the ‘Timed up and Go test’
What is syncope?
a transient loss of consciousness due to global cerebral hypoperfusion with rapid onset, short duration and spontaneous complete recovery
What is reflex syncope?
Vasovagal, situational or carotid sinus syncope
An inappropriate loss of sympathetic tone which either causes a vaso-depressor effect (blood vessels dilate) or cardio-inhibitory effect (low hr)
What is orthostatic syncope?
Syncope resulting from a postural decrease in bp either from low peripheral resistance (e.g. vasodilators drugs, or structural damage to ANS) or from low cardiac output and inadequate venous returns (e.g. hypovolaemia, chronic venous insufficiency or diuretics)
Causes of orthostatic syncope?
primary autonomic failure: Parkinson’s disease, Lewy body dementia
secondary autonomic failure: e.g. Diabetic neuropathy, amyloidosis, uraemia
drug-induced: diuretics, alcohol, vasodilators
volume depletion: haemorrhage, diarrhoea
