Falls

Question 1

What is the first year post-fracture mortality rate in post-menopausal women?

Answer 1

12-40%

Question 2

People 75 and older who fall are ______ times more likely to be admitted to a long-term care facility for a year of longer?

Answer 2

4-5x

Question 3

What is the leading cause of unintentional injury hospitalization and death among older Mainers?

Answer 3

Falls

Question 4

On average, a Maine resident over the age of 65 is hospitalized every _____ minutes from a fall related injury

Answer 4

Seven

Question 5

What is the most common type of fall in the hospital setting?

Answer 5

Anticipated physiological

Question 6

What is the most common type of fall in the community?

Answer 6

50-67% accidental falls in the home

25-45% accidental falls are environmental

Question 7

Death, injury, restricted mobility, difficulty with ADL and IADL’s, fear of falling, increase risk of LTC placement, new caregiver responsibilities, risk of early death, social isolation, financial burden are all consquences of what?

Answer 7

Falling

Question 8

What do we know about preventing falls?

Answer 8

1. Reasons for falling and risk factors
2. Accumulation model
3. Effective Interventions

Question 9

What is the most potent intrinsic factor for falls?

Answer 9

Previous falls

Question 10

What are some extrinsic factors? Aka, what in the environment can lead to falls?

Answer 10

Shoes, layout, restraints, furniture, surfaces, handrails, lighting, contrast

Question 11

In terms of medications, the strongest risk factor is polypharmacy. What does this mean?

Answer 11

> 3 medications

Question 12

What are some individual drug classes to consider for fall risks?

Answer 12

1. Serotonin-reuptake inhibitors
2. Tricyclic antidepressants
3. Anti-hypertensives
4. Class IA anti-arrhythmics
5. Neuroleptics
6. Benzodiazapines
7. Laxatives/Diuretics
8. NSAIDs
9. Sedatives/Hypnotics

Question 13

What are some periods in one’s life where we might be at a higher risk for a fall?

Answer 13

1. Acute illness/Exacerbation of chronic illness
2. Institutionalization
3. Home and Community-based Care recipients
4. Transitions of care (1 month post hosptial discharge and new living environments)

Question 14

I don’t know how to make this a question, just know its important to fix visual impairment…

Answer 14

HI GUYS!

Question 15

What vitamin should we be supplementing in the elderly?

Answer 15

Vitamin D

*all patients with proven or suspected definiciency

Question 16

How can improve target balance and strength in the “at risk for falls” population?

Answer 16

All adults should be offered exercise options to meet their needs.

Question 17

Balance Training Program Recommendations–what would these recommendations looks like for someone who is low to moderate risk?

Answer 17

Non-targeted, group exercise programs that include strength balance, flexibility, and aerobic endurance component

Question 18

Balance Training Program Recommendations–what would these recommendations looks like for someone who is at high risk?

Answer 18

Targeted interventions, trained professionals, long duration/lower intensity, responsive to changing status, and complicated patient

Question 19

What are some examples of when we should screen for falls?

Answer 19

Every adult 65 years and older

Every healthcare encounter

Every healthcare provider

Assessments are effective only if an intervention is applied.

Question 20

What are our 3 “must ask” screening questions?

Answer 20

1. Have you had 2 or more falls in the past year?
2. Have you been injured in a recent fall?
3. Do you have difficulty with walking or balance?

Question 21

What are some recommended physical screening tests?

Answer 21

1. Orthostatic BP check
2. Timed Up and Go Test
3. 30 second chair stands test
4. Quiet standing balance
   - Feet together stance, semi-tandem stance, tandem stance, single leg stance

Question 22

What is the Time Get up and Go test?

Answer 22

1. Patient rises from a standard arm chair
2. Walks 3m (10 feet) to a line on floor
3. Returns to chair and sits down

Question 23

For the Timed Get Up and Go Test, what length of time is associated with elevated fall risk?

Answer 23

12 seconds or more to complete the test

Question 24

For the Balance in Quiet Standing Test, what length of time suggests high risk for injurious fall.

Answer 24

30 seconds suggest low fall risk

Question 25

What is the most powerful predictor for assessing fall risk?

Answer 25

Gait Speed

Question 26

What makes communication about falls so difficult?

Answer 26

1. Sensory/cognitive impairment
2. Office visit time
3. Reactive health care model
4. Complex medical conditions
5. Cultural beliefs re: stoicism, ageism

Question 27

When obtaining a history on a fall, what are some important questions to ask?

Answer 27

1. Define the fall
2. How many falls in the last 3, 6, 12 months
3. Near falls?
4. Circumstances of falls or near falls
5. Associated symptoms?

Question 28

What are the names of cognitive assessments that we can use to assess dementia–and in turn fall risk?

Answer 28

Montreal Cognitive Assessment (MoCA)

Mini-Cog