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Geriatrics > Falls > Flashcards

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
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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
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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)

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4
Q

gait characteristics of 80 yo

A
  • Shorter, broader strides
  • Longer stance
  • Shorter swing duration
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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!!
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6
Q

number one problem with walking

A

-degenerative joint disease (arthritis)

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7
Q

hydrocephalus gait

A
  • predicts functional decline
  • for community dwelling elders, predicts higher risk of institutionalization
  • associated with increased morbidity and mortality
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8
Q

Trendelenburg gait

A
  • Drop in pelvis/weight to unaffected side

- Cause: hip abductor weakness, eg: gluteus medius minimus piriformis, QL

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9
Q

gluteus maximus lurch

A
  • Backward trunk lurch persists to maintain center of balance
  • Cause: hip extensor weakness eg gluteus maximus
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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
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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
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12
Q

antalgic gait

A

-short stance 2/2 pain

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13
Q

annual fall rate

A
  • 33% community dwelling elderly

- 50% nursing home residents

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14
Q

50% sustain injury

A
  • 2% hip fracture

- 5% other fracture

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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
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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

Geriatrics (7 decks)

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