Falls Flashcards
When an older person cannot get up after a fall what are some of the common complications?
Dehydration, hypothermia, pressure sores and pneumonia
What are the three main groups that falls can be categorized into?
fall due to acute illness, single/accidental fall, recurrent falls.
Aside from diagnosing the relevant medical conditions what are the other main components of a falls risk assessment?
Vision assessment, medication modification, muscle strength and balance training and assessment of home hazards
What are some typical fall related conditions that can be found watching a patient walk?
Previous stroke, peripheral neuropathy, Parkinsonism, severe arthritis, cerebellar or vestibular issues, foot drop
What is the get up and go test?
The patient is asked to rise from a chair (if possible without using their arms) walk three meters turn around, walk back to the chair and sit down again
What are the two main indications to consider syncope when assessing falls?
The patient cannot explain the fall or does not remember hitting the ground
Carotid sinus massage and tilt testing are what kind of falls investigation?
Syncope investigations
What are the three types of lightheaded sensation associated with falls?
Light headed/not right on standing/walking around, vertigo and fuzzy all the time.
What are hypoglycemia and cardiac arrhythmia examples of in relation to falls?
Posture independent causes of lightheaded sensation
When patients explain the feeling of postural hypo-tension what expression aside from light headed is used frequently?
They feel “not right” or “off balance”
When should postural hypo-tension be suspected?
When the light headed symptoms occur mainly when the patient stands up or is walking around Also if the patient has low blood pressure or is taking anti-hypertensive medication
What does the term vertigo refer to?
Sensation of movement in any direction (not just a spinning sensation)
What type of vertigo is indicated by brief vertigo on looking up?
Vertebrobasilar insufficiency
What are the four main types of vertigo associated with falls
Benign paroxysmal positional vertigo, Vestibular neuronitis, Endolymphatic hydrops (Menieres syndrome) and decompensated vestibular disorder
Characterize benign paroxysmal positional vertigo
Brief (in the range of seconds) vertigo after turning head in a certain position usually upwards e.g. lying flat or looking up towards shelves. can also present with balance problems and falls
Characterize Vestibular neuronitis
Acute onset and lasts several days. Sometimes follows a short time after a viral infection. No other neurological symptoms or signs present except horizontal nystagmus. No other ear symptoms
Characterize Endolymphatic hydrops (Meniere’s syndrome)
Can be idiopathic (Meniere’s) or secondary to auto immune disease, hypothyroidism and other conditions. Causes recurrent episodes of vertigo that last several hours and can be incapacitating. Is associated with hearing loss and tinnitus in one or both ears
Characterize Decompensated vestibular disorder
Brief vertigo on turning in any direction/ general unsteadiness and possibly falls. Can follow stroke, vestibular neuronitis or Menieres which never fully recovered.
What are the two main considerations for unsteadiness characterized as “fuzzy all the time”
Diffuse cerebrovascular disease or medication related (often anti- epilepsy medication)
What is needed to confirm postural hypo-tension
A drop in blood pressure of either 20mmHg systolic or 10mmHg diastolic
What factors related to blood volume contribute to postural hypo-tension
Dehydration (can be caused by vomiting diarrhea, fever, heat related illnesses and medications such as diuretics) Blood loss (and other forms of anemia)
What factors related to artery and vein function contribute to postural hypo-tension
Drugs such as sildenfil (Viagra) Vardenafil (Levitra) and Tadalafil (Cialis) can cause blood vessel dilation. This can be compounded by vasodilators such as nitrates. Alcohol and narcotic analgesics can also contribute. Hardening of the arteries or atherosclerosis that develops with age.
What factors related to the strength of the heart as a pump contribute to postural hypo-tension
Cardiac arrhythmias, congestive heart failure, myocardial infarction, myocarditis, pericarditis, valvular heart disease
What factors related to the autonomic nervous system contribute to postural hypo-tension
Medications such as Beta blockers. Deterioration of the Purkinje fibres. Diabetic neuropathy. (Diabetes also brings the risk of dehydration)
