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Aging and Complex medicine > Falls > Flashcards

Falls Flashcards

1
Q

what ages should males and females be assessed for fracture risk?

A

females - 65 years
males - 75 years

consider between these ages and 50 years old in the presence of the following risk factors

  • previous fragility fracture
  • current or frequent use of glucocorticoids
  • history of falls
  • family history of hip fracture
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2
Q

how is the 10 year probability of a fragility fracture calculated?

A

using FRAX or QFracture risk tools

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3
Q

when should oral bisphosphonates be commenced relating to 10 years probability of fragility fractures?

A

10 year probability is at least 1%

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4
Q

when should IV bisphosphonates be commenced?

A

when 10-year probability of fragility fractures is at least 10%
or if a patient can not tolerate oral ones

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5
Q

name 2 medications as alternatives if a post menopausal women can not take bisphosphonates

A 
- DENOSUMAB 
or 
- RALOXIFENE
or 
- RANELATE
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6
Q

Mechanism of action of Raloxifene?

A

selective oestrogen receptor modulator

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7
Q

mechanism of action of strontium ranelate

A

increases deposition of new bone by osteoblasts ansd reduces the resorption of bone by inhibiting osteoclasts

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8
Q

mechanism of action of denosumab

A

human monoclonal antibody that inhibits RANK ligand which in turn inhibits the maturation of osteoclasts

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9
Q

name a contraindication of taking oral bisphosphonates?

A

swallowing problems or pre existing oesophageal disease e.g. barrets oesophagus

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10
Q

what is sarcopaenia?

A

reduction in muscle mass

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11
Q

by what mechanism does postural hypotension arise from?

A

reduced baroreceptor sensitivity with ageing

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12
Q

1st line investigations in a patient presenting with falls?

A
  • blood glucose
  • lying and standing blood pressure
  • gain assessment
  • ECG
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13
Q

history of intermittent vertigo, precipitated by change in head position

A

BPPV

benign, paroxysmal positional vertigo

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14
Q

Interventions (2) that have been shown to reduce both risk and rate of falls?

A
  • exercise programmes; containing strength and balance training
  • home hazard assessment
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15
Q

most common side effects of bisphosphonates?

A

heartburn and indigestion

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16
Q

when should oral bisphosphonate therapy be reviews?

A

3-5 years time

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17
Q

what is the pnuemonic DAME for and what does it stand for

A
  • causes of falls in the elderly
  • Drugs
  • Ageing related
  • Medical causes
  • Environment
18
Q

Drug causes of falls in the elderly?

A
  • polypharmacy
  • antihypertensives
  • sedatives
  • opioids
  • psychotropics
19
Q

Ageing related causes of falls in the elderly?

A
  • visual changes
  • OA
  • decreased muscle bulk
  • gait abnormalities: increased postural sway
  • cognitive decline
20
Q

Medical causes of falls in the elderly? (3)

A
  • Neurological: neuropathy, strokes, parkinsons
  • Cataracts
  • Cardiac: arrhythmias
21
Q

Environmental causes of falls in the elderly?

A
  • walking aids
  • footwear
  • fear of falling
  • wrong length walking stick
22
Q

history questions to ask relating to prior to the fall?

A
  • time of day
  • where were they
  • any pattern to recurrent falls
  • prior symptoms
  • why do they think they fell
23
Q

history questions to ask relating to during the fall?

A
  • loss of consciousness

- injuries

24
Q

history questions to ask relating to after the fall?

A
  • did you get help
  • were you able to get up yourself
  • any complications e.g. head injury, fracture, hypothermia, pneumonia, dehydration, pressure sores
25
Q

name 3 causes of vertigo (peripheral)

A

1) BPPV
2) Vestibular neuronitis
3) Meniere’s disease

26
Q

what are the 3 patterns dizziness comes in?

A
  • light headedness
  • vertigo
  • feeling fuzzy all the time
27
Q

what symptoms does a patient with BPPV experience?

A

sudden onset of dizziness and vertigo triggered by changes in head position, e.g. looking one way/turning round in bed or gazing upwards

28
Q

name 4 causes of central vertigo

A
  • multiple sclerosis
  • brainstem ischaemia
  • cerebellar stroke
  • migraine
29
Q

how long do episodes of BPPV last?

A

10-20 seconds

30
Q

symptomatic relief for BPPV?

A
  • Epley maneuvre
  • Vestibular rehabilitation exercises
  • Betahistine
31
Q

how is postural hypotension diagnosed?

A

lying and standing blood pressure

32
Q

how is lying and standing blood pressure measured?

A

Patient is asked to lie down for 5 minutes, after which blood pressure is measured followed by standing up and standing blood pressure measured within 1 minute, another BP measurement after standing up for 3 minutes

33
Q

What is a positive postural hypotension lying and standing blood pressure measurement in relation to the systolic BP

A

drop in sysolic more than or equal to 20 mmHg

34
Q

What is a positive postural hypotension lying and standing blood pressure measurement in relation to the diastolic BP

A

Drop in diastolic of 10 mmHg with symptoms

35
Q

what is a psychogenic cause of falls?

A
  • common, fear of falling with confidence loss
36
Q

how does baroreceptor sensitivity change with ageing

A

decreases

37
Q

list the ways a physiotherapist helps to manage a patient with falls?

A
  • 6 weeks falls class for balance training and strength retraining
  • training can include showing ways to get up if fall over in the future
  • either in a group or individual classes
38
Q

podiatrist role in managing a patient with falls?

A

footwear advice for more supportive shoes

39
Q

pharmacist role in managing patient with falls

A

prescription review and omit certain medications such as antihypertensives

40
Q

role of occupational therapy for managing a patient with falls

A

home visit to assess environment; lighting, panic alarm system, environmental hazards, home adaptations

Aging and Complex medicine (9 decks)

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