Falls Flashcards
What is syncope?
The medical term for fainting or passing out
What causes syncope?
A temporary drop in the amount of blood that flows to the brain
What is syncope characterised by?
- Fast onset
- Short duration
- Spontaneous recovery
What symptoms might be present before the loss of consciousness with syncope?
- Light-headedness
- Sweating
- Pale skin
- Blurred vision
- Nausea or vomiting
- Feeling warm
What are the important systems involved in balance?
- Vision
- Proprioception, or joint position sense
- Vestibular system
- Brain
- Effector mechanisms
How is vision involved in balance?
Required for spatial orientation
Give 4 things that affect vision?
- Cataracts
- Age-related macular degeneration
- Diabetic retinopathy
- Bifocal lenses
How is proprioception involved in balance?
Helps with orientation when eyes are shut or vision is impaired
Give 3 things that affect proprioception
- Sensory neuropathy
- Joint replacements
- Ageing
How is vestibular system involved in balance?
Helps with orientation in 3D
How does the vestibular system help with orientation in 3D?
By use of 3 semi-circular canals at 90 degrees to each other
What does the vestibular system respond to?
Responds rapidly to head movements
Give 3 things that affect the vestibular system
- Previous middle ear infections
- Meniere’s disease
- Ototoxic drugs
How does the brain help with balance?
Helps to integrated and co-ordinate the sensory input, and tells the body what to do in order to counteract any challenge to upright posture
Give 3 things that affect the brain
- Cerebrovascular disease
- Dementia
- Low blood pressure
What effector mechanism in particular affects balance?
Quadriceps muscle
How are effector mechanisms involved in balance?
They are the main mechanism the body uses to re-balance
Give 3 things that affect effector mechanisms
- Proximal myopathy
- Any neurological disease
- Disuse atrophy
Give 2 causes of proximal myopathy
- Steroid exposure
- Vitamin D deficiency
What is it important to check in a person who has fallen?
Postural cardiovascular system reflexes
Why is it important to check the postural cardiovascular system reflexes in someone who has fallen?
Because in someone who is vulnerable, a reduction in brain perfusion on standing can give rise to disequilibrium and so a fall
What investigations to check postural cardiovascular reflexes should all patients have following a fall?
- ECG
- Postural BP
What further investigation to check postural cardiovascular reflexes might some patients require?
Detailed assessment using tilt table
What is the baroreflex?
A homeostatic mechanism that helps to maintain BP at nearly constant levels
How does the baroreflex work?
It provides a rapid negative feedback loop, in which an elevated BP reflexively causes the HR to decrease and therefore the BP to decrease
What are baroreceptors found?
In the aortic arch and carotid sinus
What is the importance of baroreceptors being found in the carotid sinus?
Carotid sinus massage will cause a slowing of the pulse and a dramatic fall in BP
What is the main risk factor for falling?
History of falling, particularly in last 12 months
What are the other risk factors for falls?
- Age <80
- Female gender
- Low weight
- Dependancy in ADL
- Medical problems
- Medication and polypharmacy
- Inappropriate footwear
- Environmental factors
What medical problems increase the risk of falls?
- Orthostatic hypotension
- Diabetes mellitus
- Confusion and cognitive impairment
- Disturbance in vision
- Gait disorders
- Urinary incontinence
- Depression
- Muscle weakness
In addition to the risk factors for falls, what other risk factors should be looked at in falls?
Risk factors for fracture of proximal femur
What are the risk factors for fractures of proximal femur?
- Weak bones
- Poor self protection
What can cause weak bones?
- Osteoporosis
- Osteomalacia
- Paget’s disease of bone
- Mets to bone
What can cause poor self-protection?
- Lack of protective SC fat
- Neurological problems preventing reflex breaking or cushioning of fall
- Falls associated with LoC
- Motor and sensory problems
What can the causes of falls be divided into?
- Environmental factors
- Poor power and balance
- Neurological problems
- Alcohol
- Syncope
- Seizures
- Drop attacks
- Visual disturbance
- Medication
Give 3 environmental factors that can cause falls
- Loose rugs/mats
- Electricity leads
- Poor lighting
Give 5 neurological problems that can cause falls
- Strokes
- Parkinson’s disease
- Neuropathy, e.g. caused by diabetes
- Proximal myopathy
- Cognitive impairment
How can alcohol cause falls?
- Acute intoxication
- Consequences of chronic alcoholism
What consequences of chronic alcoholism can cause falls?
- Polyneuropathy
- Wernicke’s encephalopathy
- Korsakoff’s psychosis
What are drop attacks?
When the cause of fall is unknown, the event is unexpected, and there is no loss of consciousness