Falls Flashcards
Define fall
Inadvertently coming to rest on the ground or other lower level without loss of consciousness and other than a consequence of sudden onset of paralysis, epileptic seizure, excess alcohol intake or overwhelming physical force
What % of community dwellers >60 fall every year?
30%
What % of community dwellers >80 fall every year?
40%
What % of people in hospital/care facilities fall every year?
50%
How common are falls?
One fall related death every 5 hours in the UK
1% of falls result in what?
Hip fracture
Mortality in elderly who fall is how much higher than that of someone under 65yo?
10x
Which gender falls more?
Males across all age groups
What age falls more?
The older you are the more likely you are to fall
What are possible outcomes after a fall?
Injury (50%) - soft tissue, fracture, subdural etc. Rhabdomyolysis (inc. CK) Loss of confidence/fear of falling Inability to cope Dependency or decreased QoL Carer stress Institutionalisation Terminal decline
What are the risk factors for falling?
Muscle weakness Hx of falls Gait defect Balance deficit Use of assistive devices Visual defect Arthritis Impaired? Depression Cognitive impairment Age > 80
What kind of factors contribute to falls?
Extrinsic
Intrinsic
Situational
What are the intrinsic factors that may contribute to a fall?
Gait and balance problems (postural instability/vertigo) Syncope (cardiac, vagal, other) Chronic dx (neuro, MSK) Visual problems Acute illness Cognitive disorder Vit D deficiency
What situational factors may contribute to a fall?
Medications
Alcohol
Urgency of micturition
What medications may increase fall risk?
Antidepressants, esp TCAs Antipsychotics Anticholingerics, antimuscarinics Benzodiazepines Anti-HTN Diuretics
What extrinsic factors may contribute to a fall?
Poor lighting
Inappropriate footwear
Environmental hazards (uneven paving, carpets, walking aids, stairs)
What is cerebral perfusion reliant on?
Vasomotor tone
Cardiac output
What are the two kinds of balance?
Static
Dynamic
What factors may affect postural stability?
Posture and balance
Cerebral perfusion
What is involved in the control of balance?
Sensory input (visual, vestibular, proprioceptive)
Central processing by cerebellum, cerebrum, basal ganglia, brainstem)
Muscular activity
