Falls Flashcards
what ages should males and females be assessed for fracture risk?
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
how is the 10 year probability of a fragility fracture calculated?
using FRAX or QFracture risk tools
when should oral bisphosphonates be commenced relating to 10 years probability of fragility fractures?
10 year probability is at least 1%
when should IV bisphosphonates be commenced?
when 10-year probability of fragility fractures is at least 10%
or if a patient can not tolerate oral ones
name 2 medications as alternatives if a post menopausal women can not take bisphosphonates
- DENOSUMAB or - RALOXIFENE or - RANELATE
Mechanism of action of Raloxifene?
selective oestrogen receptor modulator
mechanism of action of strontium ranelate
increases deposition of new bone by osteoblasts ansd reduces the resorption of bone by inhibiting osteoclasts
mechanism of action of denosumab
human monoclonal antibody that inhibits RANK ligand which in turn inhibits the maturation of osteoclasts
name a contraindication of taking oral bisphosphonates?
swallowing problems or pre existing oesophageal disease e.g. barrets oesophagus
what is sarcopaenia?
reduction in muscle mass
by what mechanism does postural hypotension arise from?
reduced baroreceptor sensitivity with ageing
1st line investigations in a patient presenting with falls?
- blood glucose
- lying and standing blood pressure
- gain assessment
- ECG
history of intermittent vertigo, precipitated by change in head position
BPPV
benign, paroxysmal positional vertigo
Interventions (2) that have been shown to reduce both risk and rate of falls?
- exercise programmes; containing strength and balance training
- home hazard assessment
most common side effects of bisphosphonates?
heartburn and indigestion
when should oral bisphosphonate therapy be reviews?
3-5 years time
what is the pnuemonic DAME for and what does it stand for
- causes of falls in the elderly
- Drugs
- Ageing related
- Medical causes
- Environment
Drug causes of falls in the elderly?
- polypharmacy
- antihypertensives
- sedatives
- opioids
- psychotropics
Ageing related causes of falls in the elderly?
- visual changes
- OA
- decreased muscle bulk
- gait abnormalities: increased postural sway
- cognitive decline
Medical causes of falls in the elderly? (3)
- Neurological: neuropathy, strokes, parkinsons
- Cataracts
- Cardiac: arrhythmias
Environmental causes of falls in the elderly?
- walking aids
- footwear
- fear of falling
- wrong length walking stick
history questions to ask relating to prior to the fall?
- time of day
- where were they
- any pattern to recurrent falls
- prior symptoms
- why do they think they fell
history questions to ask relating to during the fall?
- loss of consciousness
- injuries
history questions to ask relating to after the fall?
- did you get help
- were you able to get up yourself
- any complications e.g. head injury, fracture, hypothermia, pneumonia, dehydration, pressure sores
name 3 causes of vertigo (peripheral)
1) BPPV
2) Vestibular neuronitis
3) Meniere’s disease
what are the 3 patterns dizziness comes in?
- light headedness
- vertigo
- feeling fuzzy all the time
what symptoms does a patient with BPPV experience?
sudden onset of dizziness and vertigo triggered by changes in head position, e.g. looking one way/turning round in bed or gazing upwards
name 4 causes of central vertigo
- multiple sclerosis
- brainstem ischaemia
- cerebellar stroke
- migraine
how long do episodes of BPPV last?
10-20 seconds
symptomatic relief for BPPV?
- Epley maneuvre
- Vestibular rehabilitation exercises
- Betahistine
how is postural hypotension diagnosed?
lying and standing blood pressure
how is lying and standing blood pressure measured?
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
What is a positive postural hypotension lying and standing blood pressure measurement in relation to the systolic BP
drop in sysolic more than or equal to 20 mmHg
What is a positive postural hypotension lying and standing blood pressure measurement in relation to the diastolic BP
Drop in diastolic of 10 mmHg with symptoms
what is a psychogenic cause of falls?
- common, fear of falling with confidence loss
how does baroreceptor sensitivity change with ageing
decreases
list the ways a physiotherapist helps to manage a patient with falls?
- 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
podiatrist role in managing a patient with falls?
footwear advice for more supportive shoes
pharmacist role in managing patient with falls
prescription review and omit certain medications such as antihypertensives
role of occupational therapy for managing a patient with falls
home visit to assess environment; lighting, panic alarm system, environmental hazards, home adaptations
