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bHCE > Falls > Flashcards

Falls Flashcards

1
Q

What are the common causes of falls?

A

BPPV (Benign Paroxysmal Positional Vertigo)

Cardiac – e.g. arrhythmia

Chemical – e.g. Intoxication / alcohol / pharmacological

Neurological – e.g. seizure, stroke, peripheral neuropathy

Infection (commonly a UTI)

Vessels – e.g. Vasovagal/postural hypotension

Environmental (poor lighting / uneven surface) – rare!

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2
Q

What are the 5 systems involved in balance?

A

Vision

Proprioception

Vestibular system

Brain

Effector mechanisms

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3
Q

What are the common ways vision can be affected such that it affects balance?

A

i) age-related macular degeneration
ii) bifocal lenses
iii) cataracts
iv) diabetic retinopathy

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4
Q

What are the common ways proprioception can be affected such that it affects balance?

A

Proprioception is aided by joint position, thus;

i) sensory neuropathy
ii) joint replacements
iii) ageing

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5
Q

What are the common ways the vestibular system can be affected such that it affects balance?

A

i) previous middle ear infections
ii) menière’s disease
iii) ototoxic drugs

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6
Q

What are the common ways the effector mechanisms can be affected such that it affects balance?

A

i) proximal myopathy (e.g. steroid exposure, vitamin D deficiency)
ii) any neurological disease
iii) disuse atrophy

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7
Q

How does proprioception and joint position aid balance?

A

It helps when the eyes are shut

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8
Q

Which effector mechanisms are most commonly associated to falls?

A

Quadriceps as they are the main muscle the body uses to re-balance

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9
Q

What are the common ways the brain can be affected such that it affects balance?

A

i) cerebrovascular disease
ii) dementia (affects judgment)
iii) low blood pressure (reduces cerebral blood flow)

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10
Q

What is the sensitivity/specificity of postural hypotension testing in falls?

A

It is sensitive only. i.e. If found to have postural hypotension this is useful.

BUT if found not to this is not helpful as they may still have it

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11
Q

What should you be particularly vigilant about with a pt at risk of falls from postural hypotension?

A

hypotensive drugs

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12
Q

What are the testas you should do after a pt has a fall

A

1) CVS + RS examination
2) GALS examination
3) ECG (check for AF)
4) Lying + standing BP
5) Urine dip (UTI)
6) Neuro obs very regularly for first 5 hours

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13
Q

What is vasodepressor carotid sinus hypersensitivity (CSH)?

A

a symptomatic drop in systolic blood pressure

of 50mmHg or more

in response to carotid sinus massage

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14
Q

What types of carotid sinus hypersensitivity (CSH) are there?

A

Vasodepressor
Cardioinhibitory
Mixed

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15
Q

What is cardioinhibitory CSH?

A

Where carotid sinus massage prompts asystole

of 3 seconds or more

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16
Q

What is the best way to screen for falls?

A

Opportunistically ask patients if they have fallen in the last year

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17
Q

How are risk factors for falls broadly split?

A

Intrinsic (i.e. the body)

Extrinsic (i.e the enviroment

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18
Q

What are the three broad categories of intrinsic factors?

A

CV

neurological

Musculoskeletal

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19
Q

Name 5 common intrinsic risk factors for falls.

A

Metastatic prostate cancer

Thyrotoxicosis

Diabetes

Cognitive impairment

Muscle weakness

20
Q

Are medications intrinsic or extrinsic risk factors for falls?

A

extrinsic

21
Q

What medications are common culprits of causing falls?

A

Antihistamines

Beta-blockers

Benzodiazepines

Diuretics

Neuroleptics (aka antipsychotics)

Nitrates

Steroids

TCA’s

22
Q

What are the three biggest risk factors for falls

A

Cognitive impairment
Muscle weakness
Home hazards

23
Q

What is the common underlying cause of fractures in the elderly?

A

Osteoperosis

24
Q

How do beta-blockers induce falls?

A

Reduce heart rate

lower blood pressure

reduce cerebral perfusion

25
Q

How do nitrates induce falls?

A

Lower BP and

reduce cerebral perfusion

26
Q

How do benzodiazepines induce falls?

A

Increase drowsiness

especially at night

for example when getting up to urinate

27
Q

How do diuretics induce falls?

A

Dehydration

reduce pre-load and cardiac output

28
Q

How do neuroleptics (aka antipsychotics) induce falls?

A

Drowsiness +

can induce Parkinsonism

29
Q

How do steroids induce falls?

A

Can cause proximal muscle weakness

30
Q

How do TCA’s induce falls?

A

Lower BP

can cause dizziness and

confusion

31
Q

How do antihistamines induce falls?

A

Drowsiness

32
Q

What can repeated falls be a marker of in the elderly?

A

Frailty

33
Q

What are the adverse consequences of falls?

A

1) Fear of falling
2) Social Isolation
3) Injuries and fractures
4) Death
5) Depression and Anxiety

34
Q

When doing a lying-standing BP how long should the patient lie down for before measuring there lying BP?

A

10 mins

35
Q

How long after the patient has stood up should you take the standing blood pressure when doing lying-standing BP?

A

Straight away

1, 3 and 5 mins

36
Q

What on a urine dip can show causes of falls?

A

White cells + nitrates –> UTI

Ketones –> Dehydration

37
Q

What are the three cornerstones of falls prevention?

A

1) Strength and balance training (physio)
2) Medical review
3) OT assessment of home

38
Q

How much physio is required to reduce falls risk?

A

50 hours

39
Q

What are the four part of medical review of falls?

A

1) Diagnose the cause(s)
2) Reduce the risk factors
3) Bone health assessment
4) medication review

40
Q

How is bone health assessed in elderly that have fallen

A

Look for evidence of previous fracture, if you cannot find consider

DEXA scan (bone density)

Ca2+ Vit D if at risk

+ bisphosphonates (e.g. clodronate) if they have actually had a fall

41
Q

At what number do prescription medications start to increase the risk of falls in elderly?

A

4 or more

42
Q

Why are elderly commonly on antihypertensives and what is the issue with this?

A

Put on to reduce CV risk, but

body alters with time such that

the antihypertensives end up doing more harm than good

43
Q

What medications can be used to prevent falls?

A

Very few, except:

Fludrocortisone (mineralocorticoid i.e. like aldosterone) with unexplained low BP to reduce postural hypotension

Vit D + calcium as well as helping bone strength can help muscle strength

44
Q

Why should a patient comes into ED due to a fall be discouraged from being admitted to hospital ?

A

No as falls risk reduction takes many weeks to come into effect

45
Q

Once you have assessed a patient medically what can you do?

A

Refer them to a falls/ fracture prevention clinic

46
Q

What difference in BP in Lying + standing BP is significant?

A

greater than
20 sys or
10 dys
is significant

bHCE (18 decks)

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