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Falls Flashcards

1
Q

Models of Frailty

A
  • Fried Frailty Phenotype Model (FFP) -Frail if 3/5 criteria
  • Unintentional weight gain
  • Exhaustion
  • Weakness
  • Slow walking speed
  • Low physical activity
  • Rockwood Frailty Index - Cumulative Deficit Model
  • Quantitative measure of health deficits with 70 items.
  • Edmonton Frailty Scale (EFS)
  • 10 domain-based assessments, quick to administer (5-10 mins). Widely used in
    clinical and community setting.
  • Comprehensive Geriatric Assessment (CGA) - GOLD standard
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2
Q

Clinical tools for assessing frailty

A
  • Fried Frailty Criteria
  • Rockwood Clinical Frailty Scale (CFS)
  • Timed Up and Go (TUG) Test
  • PRISMA-7 Questionnaire
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3
Q

Define Falls

A

An event which causes a person to, unintentionally, rest on the ground or other lower level

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4
Q

Falls causes

A
  1. Neuropsychiatric - visual impairment, Peripheral neuropathy, Vestibular dysfunction, Hearing impairment, Gait and balance disturbance, Fear of falling, Seizure disorder, stroke, head injury
  2. Cardiovascular - Syncope, Orthostatic hypotension, Carotid sinus syndrome, Post-prandial hypotension
  3. MSK - Joint buckling/instability/poor mechanical mobility, Foot problems, Sarcopaenia/osteosarcopaenia, Obesity
  4. Toxic/environmental - benzodiazepines, antidepressants, and anxiolytics, alpha-blockers, anti-hypertensives, diuretics, beta-blockers, bromocriptine, levodopa, diabetes medications (hypoglycaemia), anticholinergic medications
  5. Substance misuse
  6. Environmental hazards
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5
Q

Falls complications

A
  • Laceration
  • Traumatic head injuries
  • Fractures: 95% hip
  • Distress pain
  • Loss of independence
  • Reduced quality of life
  • Fear of falls
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6
Q

Falls emergencies

A
  • Sudden change in alertness or level of consciousness
  • New head trauma (?on anticoagulant/anti PLT)
  • Persistent pain/unable to weight bear suggesting fracture
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7
Q

8 steps

Falls assesment

A
  1. Location of the fall
  2. Activityat the time of the fall
  3. Injury obtained from the fall
  4. Any changes in level, or loss of consciousness
  5. Before, During and After a fall
  6. PMHx: DM, Cardiac, Neuro, Prev falls, Cog impairment, Vision impairment
  7. DHx: Anti-HTN, Anti-cholinergics, Anti-hyperglycaemic
  8. Social Hx: Stairs, ?POC, who live with
    ?elicit drugs, ?alcohol, ?smoking
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8
Q

Falls Ix

A
  1. ECG
  2. Urine dip
  3. BM
  4. BT: FBC, U&Es, LFTs, CRP, Bone profile, B12, Folate, Fe, ferritin,
  5. Imaging: X-rays, non-contrast CT, Dual-energy x-ray absorptiometry bone scan, Echo
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9
Q

Fall examinations

A
  1. Cardio: L/S BP, Pulse - rate, rhythm, character, murmurs
  2. MSK: Muscle strength, ROM, joints creps
  3. Neuro: Cerebellar func, Romberg, Parkinson’s, vertigo
  4. Visual
  5. Gait
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10
Q

Falls prevention Mx

A
  • Med Review: to identify possible risk of fall
  • Physio: muscle and balance training, getting up after a fall
  • Alarms: Pendant alarm, smart watch
  • Walking aids
  • Environmental assessment & modifications: OT
  • Dietician: Nutritional assessment
  • Podiatrist: Foot wear / orthotics
  • Pharmacist med review / adjustments
  • SALT: Mainly for post-stroke
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11
Q

Types of dizziness

A
  • Vertigo
  • Disequilibrium
  • Syncope / presyncope
  • Mixed
  • Other: malaise, general weakness, infection, headache
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12
Q

Dizziness causes

A
  • BBPV
  • Labyrithitis
  • Post. circulation
  • Carotid sinus syndrome
  • Vertebrobasilar insufficiency
  • Dehydration
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13
Q

Dizziness exclusion questions

A

see OME book

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14
Q

Classification of dizziness

A
  • Vertigo
  • Presyncope
  • Psycho
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15
Q
A

L/S BP
Pulse
auscultation of cardio
Dix-Hallpike
Gait
Romberg
ENT
Cranial nerves
Cog: MOCA
MSK

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16
Q

Case 1:

A

Ortho hypotension
on beta blocker –> bradycardia
reduce atenolol from 100 –> 50mg
recheck LSBP until normal
DEXA scan ?osteoporosis

17
Q

Fall threshold

A
  • Older adults has lower fall threshold
18
Q

Define the Timed Up & Go test

A

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)

8 sec

19
Q

Turn 180° test

A

Ask the person to stand up and step around until they are facing the opposite direction. If the person takes more than four steps, further assessment

20
Q

Pull test

A

Stand behind them, pull from shoulders, if > 2 steps / unsteady

21
Q

Fall clinic referral criteria

A
  1. Recurrent >2 falls
  2. Loss of consciousness, syncope, near-syncope
  3. Injury - fracture / facial injury
  4. Polypharmacy

Geriatrics (10 decks)

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