Falls Flashcards
What is a fall?
- Unintentionally coming to the ground or some lower level
- Excludes consequences of sustaining a violent blow, loss of consciousness, sudden onset of paralysis (i.e. stroke or epileptic seizure)
What are the common fall mechanisms?
- Slips & trips
- Loss of balance
- Dizziness
- Weak legs
- Unsure
Where do falls commonly occur?
- Majority outside the house (garden, footpath)
- Inside the house (lounge room, kitchen, bedroom)
Why is falling a problem?
- Loss of confidence & independence
- Reduced QOL
- Significant burden to health care resources
- Leading cause of death & hospitalisation in older adults
What are the fall rates per year?
- 1 in 3 community dwelling adults >65yo (10-20% multiple falls)
- 1 in 2 people in RACFs
What are the consequences of hip fractures?
- 50% discharged to nursing homes
- 25% never regain pre-fracture mobility
- 25% die within 12 months
What are the psychosocial & demographic risk factors of falls?
- Advanced age
- History of falls
- ADL limitations
- Inactivity
- Female gender
- Fear of falling
- Living alone
What are the medical risk factors of falls?
- Stroke
- PD
- Impaired cognition
- Depression
- Incontinence
- Acute illness
- Arthritis & foot problems
- Neurological problems
- Foot pain & complications
What are the medication risk factors of falls?
- Centrally acting medications (sleeping/anxiety drugs, antidepressants, antipsychotics)
- Use of >4 medications
- BP medication
What are the environmental risk factors of falls?
- Poor footwear
- Inappropriate spectacles
- Home hazards
What are the sensory & motor risk factors of falls?
- Poor vision
- Muscle weakness
- Poor reaction time
- Reduced vestibular function
- Reduced power
What are the balance & mobility risk factors of falls?
- Impaired gait & mobility
- Impaired ability with STS
- Poor balance in standing
- Poor balance when leaning & reaching
- Slow voluntary stepping
How can falls be prevented?
Address modifiable risk factors
What are the requirements of balance?
- Integration of sensory info re. position of the body relative to surroundings
- Ability to generate appropriate motor responses to control body movement
How does reaction time change with age?
- 25% increase in simple reaction time from age 20-60
- Increased simple reaction time = strong risk factor for falls
- Fallers have slowed reaction times in more complicated tasks (e.g. stepping)
What are the age-associated changes in neurophysiology?
- Lose of neurons: Human brain loses 10% of its weight by 90yo
- Deficits in BG can affect initiation & control of movement
- Cerebellar disorders
- Loss of myelin with age (slows rate of conduction)
- Compensatory mechanisms seen to compensate
What are the age-associated changes in cognitive function?
- Main cognitive functions affected are attention & memory
- Balance control requires attentional resources
- Decreased ability to perform dual tasks
How can muscle function reduce risk of falls?
- Increased hip, knee & ankle strength = decreased risk of falls
- Power = important for fast balance responses
- Endurance = decreased end-day fatigue
How does age affect vision?
- Visual acuity
- Contrast sensitivity
- Depth perception
- Visual field (peripheral vision)
- Increased use of spectacles
What are the age-related kinematic changes to gait?
Reduced
- Joint ROM
- Variability of movement at hip/knee
- Dynamic stability
- Vertical CoG movement
Increased head lateral movement
What are the age-related temporal changes to gait?
- Decreased speed, step/stride length/rate & swing phase
- Increase stride width, stance phase & double support
What are the age-related kinetic changes to gait?
Decreased power with push off & power absorption
What are the age-related muscle activation changes to gait?
- Increased co-activation (stiffer)
- Strategy to overcome weakness
What are the guidelines for screening falls risk?
- Ask about falls history in last 12 months
- Ask about medications, vision
- Assess peripheral sensation, strength, reaction time, balance
- Assess ability to get out of a chair (no hands), walk several paces & return
- If difficulty = more thorough assessment required
What are the paper-based falls screenings?
- Modified falls efficacy scale
- Fear of falling
- Ontario screen assessment tool
What is the difference between a falls screen & assessment?
- Screen: Identifies people at risk, referral for further assessment
- Assessment: Identifies risk factors amenable to treatment, allows tailoring of interventions
What does a physiological profile assessment involve?
- Direct assessment of sensorimotor abilities
- Assumes disease processes will manifest in impaired performance in one or more tests
What factors influence postural sway?
- Increased age
- Vision
- Proprioception
- Strength
What are trips?
- Forward rotation of the body over BOS
- Requires strong push-off reaction from support limb
What are slips?
- BOS moves relative to COM
- Shear force at foot contact > frictional force at surface
What does obstacle negotiation require?
- Longer period of time spent on one leg
- Risk of lead or trailing limb making contact with the obstacle
What are the interventions for preventing falls?
- Exercise: Home/group based strength & balance training
- Vision: Cataract surgery, wearing single lens distance glasses
- Medication use: Gradually cease benzodiazepine & antidepressant use
- Home modification (not effective in low risk group)
What does evidence show regarding cognitive interventions?
- May be helpful in reducing fear of falling & increasing community engagement
- May prolong independence
- Lack of evidence
What interventions don’t work?
- Updating glasses
- Brisk walking
- Gentle/seated exercise
- Sloppy slippers campaigns
- Stand alone home modifications
- Stand alone education programs
What is the algorithm for exercise prescription to prevent falls?
- 60-80yo (low risk): Tai chi in groups
- 70-80yo (increased risk): Group balance & strength training
- 80+ yo (increased risk): Otago exercise program
What should an exercise program include?
- Safely challenge balance
- Offer ongoing exercise
- Only include walking if safe & not at expense of balance training
- Strength training
- Increased PA
- Reaction time & coordination
- Dual tasking
- Functional & ADL
- Group training
What are the categories of balance tasks?
1) Maintaining stable position (standing/sitting)
2) Adjustments to voluntary movements (reaching, gait initiation/stepping)
3) Reactions to expected forces (catching a ball)
4) Reactions to unexpected forces (bumped in a crowd, slips/trips)
