Falls Flashcards
name 7 causes of morbidity linked with immobilisation?
hypothermia dehydration pressure sores rhabdomylosis venous thromboembolism bronchopneumonia muscular de-conditioning
name 5 physiological processes of ageing which can induce falls?
vision = smaller pupils, lens thickening (less light)
reduced reaction time
sarcopenia = reduced muscle mass and function
reduced cardiorespiratory fitness
reduced peripheral sensation and proprioception, increased postural sway
when should you be suspicious of syncope in an elderly patient?
significant facial injuries
“i just go down doctor”
what causes syncope?
arrhythmias orthostatic hypotension neurogenic (vasovagal) carotid sinus hypersensitivity valvular HD (aortic stenosis)
what is orthostatic hypotension?
fall in SBP >20mmHg or DBP >10mmHg after 3 minutes of standing
why are you twice as likely to fall if you have cognitive impairment?
it impairs judgement, visual-spatial perception and orientation
what are signs of cervical myelopathy?
high stepping gait
rombergs positive
what are signs of peripheral neuropathy?
altered sensation
wide-based gait
what are signs of lumbar stenosis?
pain / paraesthesia in legs
wide-based gait
what are signs of cerebellar ataxia?
wide-based gait
cerebellar signs
what are signs of parkinson’s disease?
shuffling gait tremor rigidity bradykinesia orthostatic hypotension
what causes falls due to vertigo and imbalance?
vestibular disease - BBPV
why are those who wear bifocal / varifocal lens at high risk of falling?
they alter depth perception
what are extrinsic factors which can result in falls?
medication alcohol environmental hazards inappropriate clothing / footwear inappropriate walking aids
what medications can increase risk of falls?
benzodiazepines neuroleptics antihypertensives antidepressants anticholinergics class 1A anti arrhythmics
polypharmacy itself (>/= 4 meds) is not an independent falls risk - true or false?
false
what examinations should take place in falls?
ABCDE neuro exam gait, balance and joints CVS visual acuity (snellen chart) incontinence assessment
how is lying and standing BP carried out in CVS examination?
1st after lying for 5 minutes
2nd after standing in first minute
3rd after standing for three minutes
what are the assessment tools for falls?
timed up and go test (TUG)
berg balance scale
tinetti score
what management of falls has strongest evidence of reducing risk?
strength and balance training - 3x week for minimum 12 weeks
what medications should be stopped and started in management of falls if indicated?
stop psychoactive medication
start calcium / vitamin D, fracture risk assessment / osteoporosis treatment
