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AGEING > Falls > Flashcards

Falls Flashcards

1
Q

Why are falls more important in elderly patients?

A
  • They are more likely to get an injury
  • More likely to suffer a fracture
  • Mortality rates are higher
  • More likely to end up in a nursing home
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2
Q

What other comorbidities can result from immobility after a fall?

A
  • Hypothermia
  • Dehydration
  • Pressure sores
  • Rhabdomyolysis
  • DVT
  • Pneumonia
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3
Q

Women fall more often that men. TRUE/FALSE?

A

TRUE

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4
Q

Patients who are in hospitals or long term care fall more often. TRUE/FALSE?

A

TRUE

50% fall per year

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5
Q

What body systems need to be engaged for a patient to be able to walk/stand safely?

A

Neuro - motor co-ordination

Senses - vision and vestibular system for balance

MSK - joint stability/ muscle strength

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6
Q

What physiological parts of ageing make older people more likely to have a fall?

A
  • Vision: smaller pupils, lens thickening=↓light
  • Sarcopenia
  • ↓Peripheral sensation and proprioception
  • ↓Cardiorespiratory fitness
  • ↓reaction time
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7
Q

Elderly patients tend to have multiple chronic conditions. Which of these can cause a fall?

A
  • Cardiovascular disease/syncope
  • Cognitive impairment
  • Neurological
  • Vestibular disease
  • Vision problems
  • Musculoskeletal/gait
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8
Q

Describe a fall due to syncope?

A
  • Pt goes pale and sweaty
  • Falls suddenly and is down for a couple of minutes
  • Is confused for a further few minutes
  • Then returns to normal
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9
Q

What are the common causes of falls due to syncope?

A 
Arrythmias
Orthostatic hypotension
Neurogenic (vasovagal)
Carotid sinus hypersensitivity
Valvular heart disease (Aortic stenosis)
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10
Q

What is the definition of orthostatic hypotension?

A

Fall in SBP >20 mmHg or

Fall in DBP >10 mmHg after 3 minutes of standing

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11
Q

Why does a cognitive impairment increase a patients risk of falls?

A

Cognitive Impairment worsens:

  • Judgement
  • Visual-spatial perception
  • Orientation
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12
Q

What neurological conditions may contribute to an increased risk of falls?

A 
Cervical myelopathy
Peripheral neuropathy
Lumbar stenosis
Cerebellar ataxia
Parkinson’s disease

ALL CONDITIONS ALTER GAIT => more likely to fall

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13
Q

Why are patients with Parkinson’s more likely to suffer a fall (aside from the altered gait)?

A

Susceptible to orthostatic hypotension

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14
Q

What vestibular disease can often cause people to fall due to “dizziness” or “vertigo”?

A

Benign Paroxysmal Positional Vertigo:

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15
Q

How is BPPV confirmed and managed in patients?

A

Confirm with Dix-Hallpike manoeuvre

treated with Epley manoeuvre = better balance

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16
Q

What common visual problems can increase fall risk?

A

Cataracts

Bi-focal/varifocal lenses - these alter patients depth perception

17
Q

What external factors can cause patients to fall?

A 
Medication
Alcohol
Environmental hazards (e.g. clutter in house)
Inappropriate clothing/footwear
Inappropriate walking aids
18
Q

What environments make elderly patients more prone to falling?

A
  • Clutter
  • Rugs
  • Poor lighting
  • No hand rails
  • Stairs
19
Q

Polypharmacy increases the risk of patients falling. TRUE/FALSE?

A

TRUE

≥4 meds independent falls risk factor

20
Q

WHat specific drug classes increase patients risk of falls?

A 
Benzodiazepines
Neuroleptics
Antihypertensives
Antidepressants
Anticholinergics
Class 1A anti-arrhythmics
21
Q

How do we screen for falls?

A

Ask any patients:

  • Have you had 2 or more falls in last 12 months?
  • Have you presented acutely with a fall?
  • Do you have problems with walking or balance?
22
Q

What examinations and clinical assessments must be carried out after a patient has had a fall?

A 
ABCDE
Neurological
Gait, balance, joints
Feet and footwear
CVS
Visual acuity
23
Q

How is a lying and standing BP taken?

A

1st BP: taken after lying for at least 5 mins
2nd BP: taken after standing in the 1st min
3rd BP: taken after standing for 3 mins
note any symptoms felt during

24
Q

Describe the “Timed up and Go” Test

A

Pt is asked to stand up from chair and walk 3 metres before turning round and returning to sitting in the chair

A time over 12 seconds indicates slow movement

25
Q

Patients should always be screened for fracture risk after a fall. TRUE/FALSE?

A

TRUE

Use FRAX tool to calculate fracture risk and assess the need for a DEXA scan or osteoporotic bone protection

26
Q

What interventions are made after patients have a fall?

A
  • Strength and balance training
  • Environmental modifications
  • Footwear and foot care
  • Vision optimisation
  • Medication review
27
Q

What medications would you consider starting after a patient has had a fall?

A

Calcium/ Vit D
osteoporosis tx
Management of any arrhythmias or cardiac pacing if req’d

AGEING (11 decks)

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