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Integrated Care > Falls > Flashcards

Falls Flashcards

1
Q

How common are falls in the elderly?

A

35% of over 65yo and 50% of over 80yo fall at least once a year

10% of falls result in fracture

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2
Q

What things would you ask about in a history of falls?

A

Before the fall - what were they doing? prodrome?

During the fall - consciousness? fitting? how long down for? incontinence? tongue biting?

After the fall - able to get up? Injuries? post fall symptoms?

Timing - when? how often? more frequent?

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3
Q

How would you systematically split up causes of falls?

A 
General
Cardiovascular
Resp
Neuro
Urinary
MSK
Senses
Social
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4
Q

What symptoms may make you think of a general cause of falls and what investigations could you request?

A

Fatigue
Weight loss

FBC - anaemia
BM - hypoglycaemia

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5
Q

What symptoms may make you think of a cardiovascular cause of falls and what investigations could you request?

A

Chest pain
Palpitations

ECG
Lying-standing BP

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6
Q

What symptoms may make you think of a respiratory cause of falls and what investigations could you request?

A

Infection
SOB

CXR

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7
Q

What symptoms may make you think of a neurological cause of falls and what investigations could you request?

A

Stroke symptoms
Seizures
Peripheral neuropathy

MRI head, CT head
Cognitive assessment
Gait assessment

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8
Q

What symptoms may make you think of a urinary cause of falls and what investigations could you request?

A

Urgency
Infection

Urine dip

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9
Q

What symptoms may make you think of a musculoskeletal cause of falls?

A

Muscle weakness

Pain

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10
Q

What symptoms may make you think of a sensory cause of falls and what investigations could you request?

A

Vision impairment

Visual fields assessment

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11
Q

What symptoms may make you think of a social cause of falls and what investigations could you request?

A

Alcohol misuse
Environmental

Tox screen
LFT
Social care assessment of living conditions

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12
Q

What mobility/function assessments can be done for elderly patients who are falling?

A

Timed up and go test
Turn 180 test
Lying standing BP

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13
Q

What happens in the timed up and go test?

A

Rise for chair without using arms
Walk 3m
Turn and sit down again

Shouldn’t be any unsteadiness or difficulty

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14
Q

What happens in the turn 180 test?

A

Ask to turn around 180 on the spot

If take more than 4 steps then further assessment is indicated

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15
Q

What negative cycle may elderly people get into following a fall?

A

Increased fear of falling –> inactivity –> muscle weakness –> increase risk of falling –> fall –> increase fear of falling

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16
Q

What interventions may be considered for falls in the elderly?

A

Home assessment and alterations
Exercises - Tai-chi
Group classes - involve exercise, break fear of falling cycle
Diagnosis and manage underlying conditions
Medication review

17
Q

What medications should be reviewed in elderly patients that are falling?

A 
Beta-blockers - bradycardia
Diabetic meds - hypoglycaemia
Anti-hypertensives - hypotension
Benzodiazepines - sedation
Antidepressants/antipsychotics
NSAID's
Antibiotics - intercurrent infection
Herbal medication
18
Q

What makes up a falls risk assessment?

A 
History and examination
Drug review
Specific symptoms review
Mobility assessment
Functional assessment
Psychological effects of fall
19
Q

What are some risk factors for falls?

A 
>80
Polypharmacy
Frail
Alcohol
Female
Environmental hazards
Previous Hx
Hypotension
Non-independent
Cognitive impairment
Visual/balance disorder
20
Q

How is bone health assessed in patients at risk of falling?

A

FRAX
Qfracture
DEXA scan

21
Q

What is the FRAX? How would you manage patients based on this?

A

Estimate 10 year risk of fragility fracture - look at age, gender weight etc.

Low risk - reassure and lifestyle advice
Intermediate risk - DEXA scan
High risk - Bone protection treatment
>10% = high risk, around this is intermediate. Scan based on guidelines and clinical judgement

22
Q

What is the Q fracture tool?

A

Risk assessment tool

Take into account wider variety of risk factors than FRAX

23
Q

What is a DEXA scan (BMD test)?

A

Look at hip and lumbar spine for mineral density

T score - in relation to young fit adults of same gender who have peak bone mineral density. Normal >-1

Z score - in relation to others of same age, gender and weight

Offer treatment if T

24
Q

What bone protection treatment can be offered?

A

Alendronic acid - take in morning, 30 mins before food, sitting upright with 240ml of water

Calcium/vitD supplementation if deficiencies

Zoledronic acid - annual injection (alternative)

25
Q

What ADR’s are associated with alendronic acid?

A

Upper GI issues:

  • oesophagitis
  • swallowing problems
  • gastric ulcers

Integrated Care (9 decks)

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