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Ageing > Falls > Flashcards

Falls Flashcards

1
Q

What morbidity is linked with immobilization ?

A 
Hypothermia
Dehydration 
Pressure sores
Rhabdomyolysis
Venous thromboembolism
Bronchopneumonia
Muscular de-conditioning
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2
Q

Describe the physiology of ageing that leads to an increased rate of falls

A

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

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3
Q

What cardiac causes commonly causes falls?

A 
Arrhythmias; AF or bradyarrhythmias
Orthostatic hypotension 
Neurogenic (vasovagal) 
Carotid sinus hypersensitivity 
Valvular heart disease; aortic stenosis
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4
Q

What is the definition for orthostatic hypotension?

A

Fall in SBP >20 mmHg
OR
Fall in DBP >10 mmHg after 3 mins of standing

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5
Q

Why does cognitive impairment lead to an increase in falls?

A

Reduced:
Impairment
Visual - spatial perception
Orientation

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6
Q

Describe cervical myelopathy (common in OA)

A

High-stepping gait

Romberg’s positive

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7
Q

Describe peripheral neuropathy

A

Altered sensation

Gait wide-based

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8
Q

Describe lumbar stenosis

A

Pain/ paraesthesia in legs

Gait wide-based

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9
Q

Describe cerebellar ataxia; alcoholism

A

Gait wide-based

Cerebellar signs

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10
Q

Describe parkinson’s disease

A

Shuffling gait
Tremor, rigidity, bradykinesia
Orthostatic hypotension

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11
Q

How is BBPV diagnosed?

A

Dix-hallpike manoeuvre

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12
Q

How is BBPV treated?

A

Epley manoeuvre

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13
Q

What type of glasses can increase falls?

A

Varifocals - alters depth perception

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14
Q

What are extrinsic risk factors for falls

A 
Medication 
Alcohol
Environmental hazards
Inappropriate clothing/ footwear
Inappropriate walking aids
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15
Q

Which medications increase falls risk

A 
Benzodiazepines
Neuroleptics
Antihypertensives
Antidepressants
Anticholinergics
Class 1A antiarrhythmics
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16
Q

In terms of medications, what is an independent risk factor for falls?

A

Polypharmacy of over 4 meds

17
Q

How should prevention of falls be achieved?

A

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

18
Q

What should be asked when someone presents with falls?

A

What happened before and after the fall
Impact/ consequence of fall
Witness account
Accurate medication list

19
Q

What should be examined neurologically in someone with falls?

A 
Cortical
Extrapyramidal 
Cerebellar
Vestibular
Peripheral
Romberg test
20
Q

What should be examined in the CVS system in someone with falls?

A

Pulse rate/ rhythm
Murmurs
Lying and standing BP

21
Q

How is a lying and standing BP performed?

A

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

22
Q

What are symptoms of orthostatic hypotension?

A 
Dizziness
Lightheadedness
Vagueness
Pallor
Visual disturbance
Feelings of weakness and palpitations
23
Q

What are commonly used assessment tools for falls?

A

Timed up and go (TUG)
Berg balance scale
Tinetti score

24
Q

Describe the strength and balance training that has been proven to reduce falls?

A

3x a week for a minimum of 12 weeks
Otago exercise programme
Tai Chi

25
Q

What other interventions aside from strength and balance training can reduce falls?

A

Environmental modifications
Footwear and foot care
Vision optimization
Patient education and treatment

26
Q

Which medications should be started in those with falls?

A

Consider calcium and vit D along side a FRAX
Manage postural hypotension
Cardiac pacing

27
Q

Describe the dix-hallpike manouevure

A

Patient sits upright
Rotate head to 45 degrees
Lie flat quickly and extend head to 20 degrees
Observe eyes 45 sec

28
Q

What is a positive dix-hallpike test?

A

Latence of onset

Rotational nystagmus - fast phase to affected side

Ageing (10 decks)

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