Falls Flashcards
What are medications that can cause a patient to be more at risk of falls?
- Diuretics
- Anti-hypertensives
- Sedatives
- Anti-cholinergics
- Hypoglycaemic agents
- Psychotropic drugs
What is the “Fear of falling” and why does it cause a higher risk of falls?
It describes a “Cautious Gait” which actually decreases walking stability.
- Decreased walking speed and step length
- Subsequent increased time that both feet are on the ground
What is a Drop attack also known as?
Carotid Sinus syndrome
What is the Carotid Sinus?
An Area of Dilatation in the Internal Carotid Artery which contains a number of baroreceptors
How does the Carotid sinus retain homeostasis with fluctuations in BP?
In response to an increased pressure within the vessel wall the resultant effect is peripheral vasodilation and decrease in HR
What happens in Carotid Sinus Syndrome (CSS)?
In CSS there is an abnormal activation of the Carotid Sinus Baroreceptors leading to symptoms secondary to Cerebral hypoperfusion.
What occurs in a “Drop Attack”?
‘Drop attack’ refers to an event whereby the person suddenly collapses without any preceding symptoms and without apparent loss of consciousness.
What is Orthostatic Hypotension?
Decreased autonomic buffering capacity, which can impair adaptation to orthostatic stress.
What can trigger Orthostatic Hypotension?
Medications
Volume depletion
Physical de-conditioning due to prolonged bed rest.
What kinds of diseases can predispose to Orthostatic Hypotension?
Diseases which cause Peripheral neuropathy e.g. DM and Amyloidosis.
- Can produce autonomic Neuropathy and neurogenic orthostatic hypotension.
Patients with which diseases suffer frequently from neurogenic orthostatic hypotension?
Patients with Parkinsons disease or LBD.
In patients with a History consistent with Drop Attacks, what further neuro-cardiovascular investigations can be done?
- Tilt table
- Carotid Sinus Massage
- Full BRUCE
- Cardiac monitoring
- ECHO
What three categories can the results from a Carotid Sinus Massage be divided into?
- Cardio-inhibitory CSS (Pause in HR > 3 secs)
- Vasodepressor CSS (Drop in Systolic BP of 50mmHg
- Mixed CSS (simultaneous combination of Both)
If negative consider referring for Tilt Table + CSM if available locally.
What is the management of Falls in older patients?
- Vision Assessment and referral.
- Home Hazard Assessment and intervention
- Medication Review with modification/ withdrawal.
- Strength and balance training
What is the length and Duration which strength and balance training should be conducted in an elderly patient with recurrent falls?
3 times a week for at least 12 weeks
