falls Flashcards
what are the risk factors for falls in the elderly?
muscle weakness
low blood pressure
vision impairment
side effects of medication
why might someone have muscle weakness?
previous stroke
neurological conditions
what is the form of low blood pressure where it drops when going from a sitting to a standing position?
positral hypotension
can be caused by
- age
- drugs (e.g beta blockers, other medication that is used to lower blood pressure)
-
what are the environmental factors for falls in the elderly?
trip hazards
- lighting
- furniture
- stairs
- wet floors
what is syncope?
fainting
could be caused by positral hypotension
what are fragility fractures?
result from mechanical forces that wouldn’t ordinarily result in fracture (low level or low energy trauma)
forces are equivalent to a fall from standing height or less
some can happen without a fall (e.g vertebral)
- bumping into something
- coughing (affects spine)
major risk factor for fragility fracture is reduced BMD (such as in osteoporosis) but can occur in individuals without osteoporosis
what characterises osteoporosis?
low bone mass
microarchitectural disruption
skeletal fragility
how is osteoporosis diagnosed?
low BMD, measured on DEXA scan (T-score)
what does osteoporosis result in?
decreased bone strength
increased risk of (fragility) fracture
why are elderly females at particular risk of osteoporosis?
post menopausal
- decreased levels of oestrogen
- more resorption than bone formation (increases activity of osteoclasts, decreases activity of osteoblasts)
why are elderly people at risk of osteoporosis?
vitamin D deficiency
- don’t go out as much
- liver and kidney issues, needed for hydroxylation of vitamin D
stem cells in bone marrow may become adipocytes - leads to lack of osteoblast formation
how are muscle and bone weakness linked (mechanostat model)?
external forces influence mass and architecture of bone
more muscle puts more strain on bone
less muscle mass causes decrease in bone mass (resorption) - conservation of energy, weighs less
what is sarcopenia?
syndrome characterised by progressive and generalised loss of skeletal muscle mass and strength
correlated with physical disability, falls, low BMD, poor quality of life and death
linked with osteopenia/osteoporosis -affect same groups of people
what are the risk factors for sarcopenia?
age
gender
level of physical activity
what is sarcopenia correlated with?
physical disability
falls
low BMD
poor quality of life and death
what may cause death after a hip fracture?
(most common)
HAI
- infections post-op
heart failure
less common
co-morbidity - other diseases
poor mobility caused by fracture
- could lead to blood clots etc
- bed sores
what does a fracture in the intracapsular region risk?
lack of blood supply to head of femur
tissue becomes necrotic
why may a hemi-arthroplasty be used?
high risk during surgery
what is teriparatide?
osteoporosis medication
competitive inhibitor of PTH to reduce bone resorption
what is alendronic acid?
osteoporosis medication
bisphosphate
allows formation of calcium phosphate
oil - (first line defence)
what is alendronic acid?
osteoporosis medication
bisphosphate
allows formation of calcium phosphate
contraindications by
oil - (first line defence)
what is raloxifene?
selective oestrogen receptor modulator
what is raloxifene?
selective oestrogen receptor modulator
what is a falls clinic used for?
rehabilitation
run by geriatrics team
MDT
- nurses
- physio
- occupational therapy
falls may cause delirium - what are the symptoms?
fluctuations
change in mood and alertness
drowsiness
what can cause delirium?
infection
medication
environment
dehydration
constipation
what can cause/ trigger delirium?
infection
medication
environment
dehydration
constipation (can be caused by strong painkillers i.e opioids)
change in environment
pain
electrolyte/metabolic abnormalities (low blood sugar, low sodium, high calcium)
underlying risk factors for delirium?
age
dementia
how can delirium be combated in a hospital setting?
familiarise environment (photos, objects)
rehydration, laxatives
review meds
continuity of care
relatives
whiteboard, clock and calendar for time passage and to combat confusion
clear distinction between night and day due to confusion about time passage
meal-times - mood trays, mealtime buddies
what are the neurological causes of falls?
confusion
cognitive impairment
depression
poor vision
poor balance
poor co ordination
what are the unmodifiable causes of falls?
age
being female
history of falls
what are the neurological causes of falls?
polypharmacy
particular drug culprits
alcohol
what are the cardiovascular causes of falls?
orthostatic hypotension
arrythmia
syncope
what are the neuromuscular causes of falls?
muscle weakness
gait disorders
- Parkinson’s
- hemiplegia
- cerebellar disease
- antalgic
- normal pressure hydocephalus
- proximal myopathy
peripheral neuropathy
- sensory ataxia
- foot drop
arthritis disorders
what are the environmental causes of falls?
home hazards
inappropriate footwear
insufficient home modifications
what are the 3 ‘other’ causes of falls?
fear of falling
incontinence
frailty syndrome
