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Physio in the Ageing > Falls > Flashcards

Falls Flashcards

1
Q

What is a fall?

A
  • 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)
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2
Q

What are the common fall mechanisms?

A
  • Slips & trips
  • Loss of balance
  • Dizziness
  • Weak legs
  • Unsure
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3
Q

Where do falls commonly occur?

A
  • Majority outside the house (garden, footpath)

- Inside the house (lounge room, kitchen, bedroom)

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4
Q

Why is falling a problem?

A
  • Loss of confidence & independence
  • Reduced QOL
  • Significant burden to health care resources
  • Leading cause of death & hospitalisation in older adults
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5
Q

What are the fall rates per year?

A
  • 1 in 3 community dwelling adults >65yo (10-20% multiple falls)
  • 1 in 2 people in RACFs
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6
Q

What are the consequences of hip fractures?

A
  • 50% discharged to nursing homes
  • 25% never regain pre-fracture mobility
  • 25% die within 12 months
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7
Q

What are the psychosocial & demographic risk factors of falls?

A
  • Advanced age
  • History of falls
  • ADL limitations
  • Inactivity
  • Female gender
  • Fear of falling
  • Living alone
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8
Q

What are the medical risk factors of falls?

A
  • Stroke
  • PD
  • Impaired cognition
  • Depression
  • Incontinence
  • Acute illness
  • Arthritis & foot problems
  • Neurological problems
  • Foot pain & complications
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9
Q

What are the medication risk factors of falls?

A
  • Centrally acting medications (sleeping/anxiety drugs, antidepressants, antipsychotics)
  • Use of >4 medications
  • BP medication
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10
Q

What are the environmental risk factors of falls?

A
  • Poor footwear
  • Inappropriate spectacles
  • Home hazards
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11
Q

What are the sensory & motor risk factors of falls?

A
  • Poor vision
  • Muscle weakness
  • Poor reaction time
  • Reduced vestibular function
  • Reduced power
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12
Q

What are the balance & mobility risk factors of falls?

A
  • Impaired gait & mobility
  • Impaired ability with STS
  • Poor balance in standing
  • Poor balance when leaning & reaching
  • Slow voluntary stepping
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13
Q

How can falls be prevented?

A

Address modifiable risk factors

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14
Q

What are the requirements of balance?

A
  • Integration of sensory info re. position of the body relative to surroundings
  • Ability to generate appropriate motor responses to control body movement
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15
Q

How does reaction time change with age?

A
  • 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)
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16
Q

What are the age-associated changes in neurophysiology?

A
  • 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
17
Q

What are the age-associated changes in cognitive function?

A
  • Main cognitive functions affected are attention & memory
  • Balance control requires attentional resources
  • Decreased ability to perform dual tasks
18
Q

How can muscle function reduce risk of falls?

A
  • Increased hip, knee & ankle strength = decreased risk of falls
  • Power = important for fast balance responses
  • Endurance = decreased end-day fatigue
19
Q

How does age affect vision?

A
  • Visual acuity
  • Contrast sensitivity
  • Depth perception
  • Visual field (peripheral vision)
  • Increased use of spectacles
20
Q

What are the age-related kinematic changes to gait?

A

Reduced

  • Joint ROM
  • Variability of movement at hip/knee
  • Dynamic stability
  • Vertical CoG movement

Increased head lateral movement

21
Q

What are the age-related temporal changes to gait?

A
  • Decreased speed, step/stride length/rate & swing phase

- Increase stride width, stance phase & double support

22
Q

What are the age-related kinetic changes to gait?

A

Decreased power with push off & power absorption

23
Q

What are the age-related muscle activation changes to gait?

A
  • Increased co-activation (stiffer)

- Strategy to overcome weakness

24
Q

What are the guidelines for screening falls risk?

A
  • 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
25
Q

What are the paper-based falls screenings?

A
  • Modified falls efficacy scale
  • Fear of falling
  • Ontario screen assessment tool
26
Q

What is the difference between a falls screen & assessment?

A
  • Screen: Identifies people at risk, referral for further assessment
  • Assessment: Identifies risk factors amenable to treatment, allows tailoring of interventions
27
Q

What does a physiological profile assessment involve?

A
  • Direct assessment of sensorimotor abilities

- Assumes disease processes will manifest in impaired performance in one or more tests

28
Q

What factors influence postural sway?

A
  • Increased age
  • Vision
  • Proprioception
  • Strength
29
Q

What are trips?

A
  • Forward rotation of the body over BOS

- Requires strong push-off reaction from support limb

30
Q

What are slips?

A
  • BOS moves relative to COM

- Shear force at foot contact > frictional force at surface

31
Q

What does obstacle negotiation require?

A
  • Longer period of time spent on one leg

- Risk of lead or trailing limb making contact with the obstacle

32
Q

What are the interventions for preventing falls?

A
  • 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)
33
Q

What does evidence show regarding cognitive interventions?

A
  • May be helpful in reducing fear of falling & increasing community engagement
  • May prolong independence
  • Lack of evidence
34
Q

What interventions don’t work?

A
  • Updating glasses
  • Brisk walking
  • Gentle/seated exercise
  • Sloppy slippers campaigns
  • Stand alone home modifications
  • Stand alone education programs
35
Q

What is the algorithm for exercise prescription to prevent falls?

A
  • 60-80yo (low risk): Tai chi in groups
  • 70-80yo (increased risk): Group balance & strength training
  • 80+ yo (increased risk): Otago exercise program
36
Q

What should an exercise program include?

A
  • 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
37
Q

What are the categories of balance tasks?

A

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)

Physio in the Ageing (10 decks)

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