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Physiotherapy in Ageing > Falls > Flashcards

Falls Flashcards

1
Q

What is the definition of a fall?

A

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.

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2
Q

What accounts for 75% of falls?

A

Slips, trips and imbalance

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3
Q

What is the rate of falls in community dwelling adults > 65 years of age?

A

1 in 3. 10-20% multiple fallers

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4
Q

What is the rate of falls in people living in residential aged care facilities?

A

1 in 2

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5
Q

How many NOF fractures occurred in Australia in 2016?

A

22,000

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6
Q

What percentage of hospitalisation is contributed to falls in older adults? How many of these suffer medical treatment?

A

50%

30%

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7
Q

What are the likelihood of each outcome after a hip fracture due to a fall?

A
  • 50% discharged to nursing homes
  • 25% never regain their pre-fracture mobility
  • 25% die within 12 months
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8
Q

What are the psychosocial and demographic risk factors for falls in older adults?

A
  • Advanced age
  • History of falls
  • ADL limitations
  • Inactivity
  • Female gender
  • Fear of falling
  • Living alone
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9
Q

What are the medical risk factors for falls in older adults?

A
  • Stroke
  • Parkinson’s disease
  • Impaired cognition
  • Depression
  • Incontinence
  • Acute illness
  • Arthritis and foot problems
  • Neurological problems
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10
Q

What medications increase the risk of falls in older adults?

A
  • Centrally acting medications (sleeping, anxiety, antidepressants)
  • Use of more than four medications
  • BP medications
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11
Q

What are the environmental risk factors for falls in older adults?

A
  • Poor footwear
  • Inappropriate eyewear
  • Home hazards
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12
Q

What are the sensory and motor risk factors of falls in older adults?

A
  • Poor vision
  • Muscle weakness
  • Poor reaction time
  • Reduced vestibular function
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13
Q

What are the balance and mobility risk factors for falls in older adults?

A
  • Impaired gait and mobility
  • Impaired ability with sit to stand
  • Poor balance in standing
  • Poor balance when leaning and reaching
  • Slow voluntary stepping
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14
Q

What are the three main components for balance?

A
  • Sensory input: loss of sensation
  • Central processing: neurological changes
  • Motor response: loss of power
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15
Q

What is the role of the spinal cord in processing?

A

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.

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16
Q

What role does the brain stem play?

A

Nuclei involved in postural control, locomotion, vestibular nuclei,
- ascending and descend pathways (transmitting sensory and motor information)

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17
Q

What occurs at the cerebellum?

A

Receives input from spinal cord and the cerebral cortex, sends information to the brain stem, modulates motor behaviour.

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18
Q

What is the role of the basal ganglia?

A

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.

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19
Q

What occurs at the somatosensory cortex?

A

Beginning of conscious awareness of somatosensation

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20
Q

What increase occurs in simple reaction time from the age of 20 to 60? What is this change contributed to?

A

25% increase.

Neurological changes.

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21
Q

What do deficits in the basal ganglia affect?

A

Can affect initiation and control of movement

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22
Q

What can cerebellar disorders cause?

A

Disequilibrium and altered interlimb coordination

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23
Q

What basic cognitive functions are most affected by age?

A
  • Attention

- Memory

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24
Q

What percentage of muscle mass has diminished by 80 years of age?

A

30 - 40%

25
Q

What percentage of strength is lost by 80 years of age?

A

~50%

26
Q

What changes occur to the fast twitch muscle fibres?

A
  • Preferential atrophy

- Reduced innervation capacity

27
Q

Muscle weakness is what muscle groups is associated with an increased risk of falls? What percentage of strength is lost each year?

A

Hip, knee and ankle

10%/year decrease from age 30, 15%/year from age 60

28
Q

What are the causes of primary sarcopenia?

A

Age-related changes

  • Sex hormones
  • Apoptosis
  • Mitochondrial dysfunction
29
Q

What are the causes of secondary sarcopenia?

A
  • Activity related: sedentary, deconditioning
  • Disease related: advanced organ failure, inflammatory disease, malignancy
    Nutrition related: inadequate energy intake, malabsorption, GI disorders, medications
30
Q

What are the conceptual stages of sarcopenia and what do they involve?

A
  1. Presarcopenia: reduced muscle mass
  2. Sarcopenia: reduced muscle mass and strength OR performance
  3. Severe sarcopenia: reduced muscle mass, strength and performance.
31
Q

How much does postural sway increase with eyes closed?

A

~30%

32
Q

What visual changes occur as a result of ageing?

A
  • Visual acuity
  • Contrast sensitivity
  • Depth perception
  • Visual field (peripheral vision)
  • Increased use of spectacles
33
Q

What temporal gait changes are observed with increased age?

A
  • Slower speed
  • Increased stride width
  • Decreased step and stride length
  • Decreased step rate (cadence)
  • Increased stance phase
  • Decreased swing phase
  • Increased double support
34
Q

What are the main muscle groups affecting gait performance?

A
  • Ankle PF and DF

- Hip flexors and extensors

35
Q

What kinetic gait changes occur with increased age?

A
  • Decreased power with push off

- Decreased power absorption

36
Q

What kinematic gait changes occur with increased age?

A

Reduced ROM:

  • decreased variability of movement at hip and knee
  • decreased dynamic stability
  • decreased vertical COG
  • increased head lateral movement
37
Q

What muscles are responsible for absorbing mechanical energy during gait?

A
  • Dorsiflexors
  • Plantarflexors
  • Knee extensors
38
Q

What muscles are responsible for generating mechanical energy during gait?

A
  • Plantarflexors

- Hip extensors

39
Q

What muscles are responsible for controlling swing during gait?

A
  • Hip flexors
  • Ankle dorsiflexors
  • Knee extensors
40
Q

What muscles are responsible for controlling lateral movement during gait?

A

Hip abductors

41
Q

What paper-based falls risk screening can be used?

A
  • Modified Falls Efficacy Scale
  • Fear of Falling
  • Ontario Screen
42
Q

What is the difference between screening an individual for falls risk and assessing?

A

Screening: identifying people at risk and referring for further assessment and intervention
Assessment: identification of risk factors amenable to treatment

43
Q

What can a quick screen for falls risk involve?

A 
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)
44
Q

What five components does the physiological profile assessment involve?

A
  1. Vision
  2. Sensation
  3. Balance
  4. Speed
  5. Strength
45
Q

What factors influence postural sway?

A
  • Increased age
  • Vision
  • Proprioception
  • Strength
46
Q

What movement is required during a trip?

A

Induces a forward rotation of the body over the base of support, requiring a strong push-off reaction from the support limb.

47
Q

What movement occurs during a slip?

A

Base of support moves relative to the centre of mass.

48
Q

Why can obstacle negotiation increase the risk of a fall?

A

Increases period of time spent in single stance and increases risk of lead or trial limb making contact with obstacle

49
Q

What did Sherrington et al (2011) meta-analysis find about the effectiveness of exercise interventions for the prevention of falls in older adults?

A

Two hours a week of moderate to challenge exercises reduced falls by 17%

50
Q

What single interventions can be used to prevent falls?

A
  1. Exercise: home or group based
  2. Vision: cataract surgery, glasses
  3. Medication: reduction of antidepressants if possible
  4. Home modification programs
51
Q

What benefit can cognitive behavioural programs have?

A

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

52
Q

For what group are home modifications most successful?

A

In high risk falls group

53
Q

What exercises result in the greatest reduction in falls?

A

Programs that involve challenging balance to a high extent, high dosage and do not include a walking program.

54
Q

What exercise is recommended for age groups over 60 years of age?

A
  • 60-80 years: tai chi groups
  • 70-80: group balance and strength training
  • 80+: Otago exercise program
55
Q

What does the Otago Exercise Program involve?

A
  • Home based strength and balance exercises
  • 4-5 sessions for prescription and progression
  • 3 x week, 30 mins
56
Q

What is the effectiveness of the Otago Exercise program? In which group was is it most beneficial?

A

Reduced falls by 35%

Most beneficial in high risk groups (over 80 years, previous falls)

57
Q

What did Wolf et al 1996 find about the effectiveness of tai chi in reducing falls risk?

A

15 week program reduced multiple falls by 47.5% over 12 months

58
Q

What are the four categories of balance tasks, in order of increasing balance requirements?

A
  1. Maintaining a stable position: sitting or standing
  2. Adjustments to voluntary movements: reaching, gait initiation
  3. Reactions to expected forces
  4. Reactions to unexpected forces

Physiotherapy in Ageing (17 decks)

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