Falls Flashcards
How is postural hypotension investigated?
A reduction in brain perfusion on standing can give rise to a disequilibrium and so a fall
Baroreflex- homeostatic mechanism that helps to maintain blood pressures at a nearly constant levels, provides a rapid negative feedback loop, which in an elevated BP reflexively causes the HR to decrease therefore BP decrease, baroreceptors found in aortic arch and carotid sinus
All patients presenting after a fall should have an ECG and postural BP checked as standard some patients may need more detailed assessment using a TILT table
Carotid sinus massage is commenced for 5 seconds using a longitudinal massage over the point of maximal carotid pulsation- this is followed by slowing of the pulse and a dramatic fall in BP
What is the definition of a fall?
An event which results in a person coming to rest inadvertently on the ground or floor or other lower level
Unintentionally coming to rest on the ground, floor or other lower level; excluding coming to rest against furniture, wall or other structure
What is the epidemiology of falls?
Every 5hrs in the UK an older person dies as a direct result of a fall
Twice as many women aged 75+ die from falls as men of the same age
Up to the age of 64 twice as many men as women die in falls
Following a hip fracture, 1 in 3 become totally dependent and 1 in 2 become partly dependent
50% of people aged 80+ fall at least once a year
The 1 year mortality in people with fractured neck of femur is 20-35%
1% of falls result in hip fracture
50% of those who fall will fall again in the next 12 months
Which disorders can affect balance?
Vision: Cataracts Age-related macular degeneration Diabetic retinopathy Bifocal lenses Proprioception: Sensory neuropathy Joint replacements Ageing Vestibular system: Previous middle ear infections Meniere’s disease Ototoxic drugs Brain: Cerebrovascular disease Dementia- affects judgement Low blood pressure- reduces cerebral blood flow Effector mechanisms: Proximal myopathy eg. steroid exposure, vitamin D deficiency Any neurological disease Disuse atrophy
Which drugs can be used to help prevent falls?
Fludrocortison is used in people with unexplained, persistently low BP to increase the circulating volume and thus raise BP
Calcium and vitamin D are used to improve muscle strength on people who are vitamin D deplete, there is evidence to suggest that vitamin D improves the function of stretch receptors and so reduce falls
What are the drugs of sedation?
Benzodiazepines Tricyclic antidepressants Anti-psychotics Barbiturates Anti-convulsants Sedating anti-histamines Analgesic opiates
Which drugs cause hypotension?
Diuretics Beta-blockers ACE inhibitors Angiotensin II blockers Alpha blockers Calcium channel blockers Vasodilators Urinary anti-muscarinics Phenothiazine TCAs Anti-parkinsonian drugs Acetylocholinesterase inhibitors
Which drugs cause reduced visual acuity/blurred vision?
Eyedrops
Anti-cholinergics
Which drugs cause muscle weakness?
Baclofen, dantrolene
Which drugs cause ataxia?
Carbamazepine, phenytoin
What are the intrinsic risk factors for falls?
Diabetes Parkinson’s Disease Thyrotoxicosis Cataracts Osteoarthritis Metastatic prostate cancer
What are the extrinsic risk factors for falls?
Highly polished wooden floors Poorly fitting slippers Walking stick Poor lighting conditions Diazepam 10mg nocte Rugs
What are the other risk factors for falls?
Female gender- ratio 1.5 Visual deficit- ratio 1.5-3.0 Medication- mainly benzodiazepams, anti-depressants and anti-psychotics – ratio 1.5 Assistive device- relative risk 2.6 Cognitive impairment- ratio 2.0-4.0 Muscle weakness- ratio 3.0 Osteoarthritis- relative risk 2.0 Home hazards- relative risk 3.6 Testosterone deficiency- relative risk 1.8
What are the risk increasing conditions for falls?
Dementia Delirium Lower urinary tract symptoms in men Stroke Urinary incontinence in neurological disease Urinary incontinence in women
What are the consequences of falls?
Fear of fall- activity limitation, participation restriction, low quality of life, anxiety and depression
Social isolation
Injuries and fractures
Carer strain- stress
Institutionalisation- the likelihood of an older people requiring admission to a care home increases with both the number and severity of falls recorded
