Falls Flashcards
What morbidity is linked with immobilization ?
Hypothermia Dehydration Pressure sores Rhabdomyolysis Venous thromboembolism Bronchopneumonia Muscular de-conditioning
Describe the physiology of ageing that leads to an increased rate of falls
Vision: smaller pupils, lens thickening, decreased light
Sarcopenia: loss of muscle mass and function
Decreased peripheral sensation and proprioception, increased postural sway
Decreased cardioresp fitness
Decreased reaction time
What cardiac causes commonly causes falls?
Arrhythmias; AF or bradyarrhythmias Orthostatic hypotension Neurogenic (vasovagal) Carotid sinus hypersensitivity Valvular heart disease; aortic stenosis
What is the definition for orthostatic hypotension?
Fall in SBP >20 mmHg
OR
Fall in DBP >10 mmHg after 3 mins of standing
Why does cognitive impairment lead to an increase in falls?
Reduced:
Impairment
Visual - spatial perception
Orientation
Describe cervical myelopathy (common in OA)
High-stepping gait
Romberg’s positive
Describe peripheral neuropathy
Altered sensation
Gait wide-based
Describe lumbar stenosis
Pain/ paraesthesia in legs
Gait wide-based
Describe cerebellar ataxia; alcoholism
Gait wide-based
Cerebellar signs
Describe parkinson’s disease
Shuffling gait
Tremor, rigidity, bradykinesia
Orthostatic hypotension
How is BBPV diagnosed?
Dix-hallpike manoeuvre
How is BBPV treated?
Epley manoeuvre
What type of glasses can increase falls?
Varifocals - alters depth perception
What are extrinsic risk factors for falls
Medication Alcohol Environmental hazards Inappropriate clothing/ footwear Inappropriate walking aids
Which medications increase falls risk
Benzodiazepines Neuroleptics Antihypertensives Antidepressants Anticholinergics Class 1A antiarrhythmics
In terms of medications, what is an independent risk factor for falls?
Polypharmacy of over 4 meds
How should prevention of falls be achieved?
Have you had 2 or more falls in the last 12 months
Have you presented acutely with a fall
Do you have problems with walking or balance
What should be asked when someone presents with falls?
What happened before and after the fall
Impact/ consequence of fall
Witness account
Accurate medication list
What should be examined neurologically in someone with falls?
Cortical Extrapyramidal Cerebellar Vestibular Peripheral Romberg test
What should be examined in the CVS system in someone with falls?
Pulse rate/ rhythm
Murmurs
Lying and standing BP
How is a lying and standing BP performed?
1st BP: taken after lying for at least 5 mins
2nd BP: taken after standing in the first min
3rd BP: taken after standing for 3 mins
What are symptoms of orthostatic hypotension?
Dizziness Lightheadedness Vagueness Pallor Visual disturbance Feelings of weakness and palpitations
What are commonly used assessment tools for falls?
Timed up and go (TUG)
Berg balance scale
Tinetti score
Describe the strength and balance training that has been proven to reduce falls?
3x a week for a minimum of 12 weeks
Otago exercise programme
Tai Chi
