Falls Flashcards
What is the definition of a fall?
Unintentionally coming to the ground or some lower level and other than as a consequence of sustaining a violent blow, loss of consciousness, sudden onset of paralysis as in a stroke or an epileptic seizure.
What accounts for 75% of falls?
Slips, trips and imbalance
What is the rate of falls in community dwelling adults > 65 years of age?
1 in 3. 10-20% multiple fallers
What is the rate of falls in people living in residential aged care facilities?
1 in 2
How many NOF fractures occurred in Australia in 2016?
22,000
What percentage of hospitalisation is contributed to falls in older adults? How many of these suffer medical treatment?
50%
30%
What are the likelihood of each outcome after a hip fracture due to a fall?
- 50% discharged to nursing homes
- 25% never regain their pre-fracture mobility
- 25% die within 12 months
What are the psychosocial and demographic risk factors for falls in older adults?
- Advanced age
- History of falls
- ADL limitations
- Inactivity
- Female gender
- Fear of falling
- Living alone
What are the medical risk factors for falls in older adults?
- Stroke
- Parkinson’s disease
- Impaired cognition
- Depression
- Incontinence
- Acute illness
- Arthritis and foot problems
- Neurological problems
What medications increase the risk of falls in older adults?
- Centrally acting medications (sleeping, anxiety, antidepressants)
- Use of more than four medications
- BP medications
What are the environmental risk factors for falls in older adults?
- Poor footwear
- Inappropriate eyewear
- Home hazards
What are the sensory and motor risk factors of falls in older adults?
- Poor vision
- Muscle weakness
- Poor reaction time
- Reduced vestibular function
What are the balance and mobility risk factors for falls in older adults?
- Impaired gait and mobility
- Impaired ability with sit to stand
- Poor balance in standing
- Poor balance when leaning and reaching
- Slow voluntary stepping
What are the three main components for balance?
- Sensory input: loss of sensation
- Central processing: neurological changes
- Motor response: loss of power
What is the role of the spinal cord in processing?
Initial reception and processing of somatosensory information (from the muscles, joints and skin), and reflexes and voluntary control of posture and movement via motor neurons.
What role does the brain stem play?
Nuclei involved in postural control, locomotion, vestibular nuclei,
- ascending and descend pathways (transmitting sensory and motor information)
What occurs at the cerebellum?
Receives input from spinal cord and the cerebral cortex, sends information to the brain stem, modulates motor behaviour.
What is the role of the basal ganglia?
It sits at the base of the cortex and receives input from most areas of the cortex and then sends information to the motor cortex via the thalamus.
What occurs at the somatosensory cortex?
Beginning of conscious awareness of somatosensation
What increase occurs in simple reaction time from the age of 20 to 60? What is this change contributed to?
25% increase.
Neurological changes.
What do deficits in the basal ganglia affect?
Can affect initiation and control of movement
What can cerebellar disorders cause?
Disequilibrium and altered interlimb coordination
What basic cognitive functions are most affected by age?
- Attention
- Memory
What percentage of muscle mass has diminished by 80 years of age?
30 - 40%
What percentage of strength is lost by 80 years of age?
~50%
What changes occur to the fast twitch muscle fibres?
- Preferential atrophy
- Reduced innervation capacity
Muscle weakness is what muscle groups is associated with an increased risk of falls? What percentage of strength is lost each year?
Hip, knee and ankle
10%/year decrease from age 30, 15%/year from age 60
What are the causes of primary sarcopenia?
Age-related changes
- Sex hormones
- Apoptosis
- Mitochondrial dysfunction
What are the causes of secondary sarcopenia?
- Activity related: sedentary, deconditioning
- Disease related: advanced organ failure, inflammatory disease, malignancy
Nutrition related: inadequate energy intake, malabsorption, GI disorders, medications
What are the conceptual stages of sarcopenia and what do they involve?
- Presarcopenia: reduced muscle mass
- Sarcopenia: reduced muscle mass and strength OR performance
- Severe sarcopenia: reduced muscle mass, strength and performance.
How much does postural sway increase with eyes closed?
~30%
What visual changes occur as a result of ageing?
- Visual acuity
- Contrast sensitivity
- Depth perception
- Visual field (peripheral vision)
- Increased use of spectacles
What temporal gait changes are observed with increased age?
- Slower speed
- Increased stride width
- Decreased step and stride length
- Decreased step rate (cadence)
- Increased stance phase
- Decreased swing phase
- Increased double support
What are the main muscle groups affecting gait performance?
- Ankle PF and DF
- Hip flexors and extensors
What kinetic gait changes occur with increased age?
- Decreased power with push off
- Decreased power absorption
What kinematic gait changes occur with increased age?
Reduced ROM:
- decreased variability of movement at hip and knee
- decreased dynamic stability
- decreased vertical COG
- increased head lateral movement
What muscles are responsible for absorbing mechanical energy during gait?
- Dorsiflexors
- Plantarflexors
- Knee extensors
What muscles are responsible for generating mechanical energy during gait?
- Plantarflexors
- Hip extensors
What muscles are responsible for controlling swing during gait?
- Hip flexors
- Ankle dorsiflexors
- Knee extensors
What muscles are responsible for controlling lateral movement during gait?
Hip abductors
What paper-based falls risk screening can be used?
- Modified Falls Efficacy Scale
- Fear of Falling
- Ontario Screen
What is the difference between screening an individual for falls risk and assessing?
Screening: identifying people at risk and referring for further assessment and intervention
Assessment: identification of risk factors amenable to treatment
What can a quick screen for falls risk involve?
Subjective: - previous falls (>1 in 12/12) - medications (>4) - vision (visual acuity) Objective: - peripheral sensation - tandem stance (10s) - alternate step test (8 taps in 15s) - STS (5 in 15s)
What five components does the physiological profile assessment involve?
- Vision
- Sensation
- Balance
- Speed
- Strength
What factors influence postural sway?
- Increased age
- Vision
- Proprioception
- Strength
What movement is required during a trip?
Induces a forward rotation of the body over the base of support, requiring a strong push-off reaction from the support limb.
What movement occurs during a slip?
Base of support moves relative to the centre of mass.
Why can obstacle negotiation increase the risk of a fall?
Increases period of time spent in single stance and increases risk of lead or trial limb making contact with obstacle
What did Sherrington et al (2011) meta-analysis find about the effectiveness of exercise interventions for the prevention of falls in older adults?
Two hours a week of moderate to challenge exercises reduced falls by 17%
What single interventions can be used to prevent falls?
- Exercise: home or group based
- Vision: cataract surgery, glasses
- Medication: reduction of antidepressants if possible
- Home modification programs
What benefit can cognitive behavioural programs have?
Significantly reduces concerns about falls, related activity avoidance, disability and indoor falls in community-living, frail older people. The program may prolong independent living and provides an alternative for those people who are not able or willing to attend group programs
For what group are home modifications most successful?
In high risk falls group
What exercises result in the greatest reduction in falls?
Programs that involve challenging balance to a high extent, high dosage and do not include a walking program.
What exercise is recommended for age groups over 60 years of age?
- 60-80 years: tai chi groups
- 70-80: group balance and strength training
- 80+: Otago exercise program
What does the Otago Exercise Program involve?
- Home based strength and balance exercises
- 4-5 sessions for prescription and progression
- 3 x week, 30 mins
What is the effectiveness of the Otago Exercise program? In which group was is it most beneficial?
Reduced falls by 35%
Most beneficial in high risk groups (over 80 years, previous falls)
What did Wolf et al 1996 find about the effectiveness of tai chi in reducing falls risk?
15 week program reduced multiple falls by 47.5% over 12 months
What are the four categories of balance tasks, in order of increasing balance requirements?
- Maintaining a stable position: sitting or standing
- Adjustments to voluntary movements: reaching, gait initiation
- Reactions to expected forces
- Reactions to unexpected forces
