Falls Flashcards
1
Q
mobility
A
- When you are coming up with your ddx, you need to think of commonalities and red flags
- Walking
- Climbing stairs
- Getting in/out of cars
- Transfers – this is medical terminology (To and from a bed, To and from a chair, To and from a wheelchair, To and from a commode)
- Getting up from the floor
2
Q
is elder mobility a problem
A
- 8-19% Community dwelling elders have difficulty walking
- 40% Nursing home residents require the help of another or special equipment to walk
- 54% of elders over the age of 85 have mobility limitations
3
Q
gait and aging
A
- Gait is specific to walking!!
- Gait changes with advanced age (Decline in gait speed, Stride length diminishes, Not due to decrease in cadence)
4
Q
gait characteristics of 80 yo
A
- Shorter, broader strides
- Longer stance
- Shorter swing duration
5
Q
common diagnoses leading to gait disorders
A
- Degenerative Joint Disease
- Sensory Impairment
- Neurological Diseases (Stroke, Parkinson’s)
- Postural Hypotension/Rx induced
- Fear of Falling
- Anything that makes the peripheral nervous system not work as well is a risk factor!!
6
Q
number one problem with walking
A
-degenerative joint disease (arthritis)
7
Q
hydrocephalus gait
A
- predicts functional decline
- for community dwelling elders, predicts higher risk of institutionalization
- associated with increased morbidity and mortality
8
Q
Trendelenburg gait
A
- Drop in pelvis/weight to unaffected side
- Cause: hip abductor weakness, eg: gluteus medius minimus piriformis, QL
9
Q
gluteus maximus lurch
A
- Backward trunk lurch persists to maintain center of balance
- Cause: hip extensor weakness eg gluteus maximus
10
Q
steppage gait
A
- Excess hip flexion to clear foot
- Cause: foot drop
- The most common = hip and knee surgery and you can cut femoral nerve
11
Q
ataxic gait
A
- Unsteady, uncoordinated, wide base, feet thrown out coming down on heel then toes
- Cause injury to cerebellum, sensory deficits of lower limb
- Looks like drunk gait
12
Q
antalgic gait
A
-short stance 2/2 pain
13
Q
annual fall rate
A
- 33% community dwelling elderly
- 50% nursing home residents
14
Q
50% sustain injury
A
- 2% hip fracture
- 5% other fracture
15
Q
Falls: meta-analysis of 12 studies
A
- Accident/environment 31%
- Gait/balance disorder 17%
- Dizziness 13%
- Drop Attack (syncope) 10%
- Confusion 4%
- Postural Hypotension 3%
- Impaired Vision 3%
- The first thing you have to think is WHAT CAUSED THE FALL?!!
- You need to ask questions to rule out the red flags in other categories
16
Q
risk factors for falling
A
- History of Falls – if you fall once, you’re more likely to fall again
- Gait Deficit
- Balance Deficit
- Strength Deficit
- Restraints – INCREASE YOUR RISK IN FALLS!!! (People who are restrained are more likely to fight their restraints and fall)
- Arthritis
- Uses assistive devices
- Impaired ADLs
- Depression
- Cognitive Impairment
- Postural Hypotension
17
Q
checklist for patients who fall
A
- History of Injuries, Accidents
- Falls within the Last 12 Months
- History of Diseases and Surgeries (DIABETES!!!!! HUGE CAUSE OF FALLS!!!)
- History of Orthopedic Procedures
- Hospitalizations
- MEDICATIONS (ANY medication can cause falls!!)
18
Q
falls and medications: the culprits
A
- Polypharmacy
- Sedative Hypnotics
- Antidepressants
- Antihypertensives
- Cardiac medications
- Hypoglycemic agents
- Topical Eye Medications (TIMOLOL!!! BETA BLOCKERS CAUSE FALLS!! BP and HR)
19
Q
diagnosing falls: review of systems
A
- Syncope? – did you lose consciousness?
- Visual Impairment?
- Shortness of Breath, Chest Pain? – is this an acute coronary event
- Neurological? (Sensory Deficit, Muscle Weakness or Pain, Poor Balance)
20
Q
checklist for patients who fall
A
- Associated Symptoms (Dizziness, Light-headedness, Vertigo, Syncope, Weakness – one sided or slurred speech, Confusion, Palpitations
- If someone is diabetic, the finger stick is the first thing you do when/if they fall
21
Q
post-fall assessment
A
- Details of the Fall (Location, Time of Day, Relationship to meals, toileting)
- Trauma Check – touch their bony protuberances!!! You should be able to palpate these areas quickly
- Postural Hypotension
- Determine Fall Risk Factors
- Check Incident Reports
22
Q
checklist for patients who fall at social/environmental history
A
- Home (Multilevels/Stairs, Pets, Hazards (Rugs, cords, poor lighting)
- Lives Alone?
- If they seem like they are a poor historian, you need to check labs, get CT, etc. (If everything comes back normal, what do you do?? – do you let them go home?)
- Assistive Devices?
- Frequently leaves home?
23
Q
response to fall in SNF
A
- Neuro checks q 1 hr x4 then q 4 hr x 24hr, check VS, check FSBS
- PE: BP, HR, bruits?, nystagmus, CNx10, muscle testing, MMSE
- PT/OT to evaluate patient’s home
24
Q
carotid sinus massage
A
- Absolutely nothing happens and this would be a negative test.
- If the test is positive then blood pressure may temporarily drop or heart rate may slow which may cause Pt to go dizzy or faint.
25
Q
falls and dizziness
A
- Was the Onset Sudden?
- Is the Dizziness Constant or Periodic?
- How Long do the Episodes Last?
- How is the Dizziness Impacting the Patient’s Life?
26
Q
common/curable dizziness
A
- Postural Hypotension – get up from the bed and got dizzy
- Benign Positional Vertigo – he diagnoses this all the time (This is dizziness from an otolith in the inner ear that is affecting the balance and proprioception)
- Anxiety
- Depression
- Cardiac Arrhythmia
27
Q
T or F: venous blood has pressure behind it
A
F
28
Q
decreasing the risk of falls
A
- Obtain a History of Falls
- Perform a Fall-Risk Assessment
- Initiate an Intervention
29
Q
fall risk assessment
A
- Gait Examination (Watch patient enter the exam room, Assess gait initiation/shuffling, Asymmetric weight distribution)
- Evaluate Gait (From the front, From the back, From the side)
30
Q
fall risk assessment: usual and maximal gait speed
A
- 5 meters adequate to assess
- Slow (0.6 meter/second) predicts hospitalization and functional decline
- Versus Fast (1.0 meter/second)
31
Q
fall risk assessment: timed get up and go
A
-Time Necessary to: Stand up from a chair with arms, Walk 3 m (10 feet), Turn, Walk back to the chair, Sit Down
32
Q
timed get up and go test
A
- Most adults can complete in 10 sec
- Most frail elders can complete in 11-20 seconds
- > 14 seconds = increased fall risk
- > 20 seconds = comprehensive evaluation indicated
33
Q
fall interventions: decreasing the risk
A
- Factors that can be Modified (Medications (* Psychotropics), Muscle Weakness, Hypotension, Restraints: increase risk of falls)
- Nonmodifiable Factors (Hemiplegia, Blindness)
34
Q
fall interventions: intrinsic
A
- Treat the Underlying Disease
- Eliminate Drugs and Dosages
- Initiate Physical Therapy (Balance and Gait Training, Vestibular Rehabilitation)
- Initiate Exercise Program (Tai Chi, Resistive)
35
Q
fall interventions: extrinsic
A
- Reduce Environmental Hazards
- Reduce/remove Restraints
- Improve Fall Surveillance (Staff, Motion Detectors, pressure pads, wander guards)
- Consider Protective Pads and Floors and/or a Low Bed
