Falls Flashcards
Why do older people fall?
Why do older people fall?
In elderly people falls are usually caused by trips and slips
In frail elderly people 15% have acute illness and about 15% have a black out or faint, the rest have multiple factors that are contributing to the fall. Frail older people have much less capacity to adjust to intermetal or external changes and so an illness can overwhelm this resulting in falls, delirium, and immobility.
What systems should be assessed after a fall?
Assess cardiovascular, neurological, urinary, MSK, senses and social problems when assessing a falls patient.
How should you go about assessing someone who has had a fall?
Is this syncopal or non-syncopal Is the patient confused or delirious? How is their gait, balance and falls risk? Vertigo and vision? Neurological assessment Cognition Other factors – weight, environment etc.
CGA including a risk assessment examining the risk factors for falls, the Hx of falls, a drug review, ADL assessment and psychological effects.
What are the risk factors for a fall?
Age > 80 Polypharmacy Frail Alcohol Female Environmental hazards Previous History of falls Hypotension Non-independent Cognitive impairment Visual/balance disorder Peripheral neuropathy
What investigations should/can be done for someone who has had a fall?
Check for injuries
ECG
Lying/standing BP – interpret with caution, should only be done when euvolemic
Medication review - both hypotensive drugs and sedatives
Gait/functional assessment
Bone health review
Assessment for fear of falling/loss of confidence
Vision
Timed up and go test – Including 180-degree turn
Rise from chair without using arms, walk 3m, turn around, walk back, and sit down again
When assessing the turn – should not take more than 4 steps
When watching assess number of steps, gait speed and chair stand.
<10s normal
11s-20s normal for frail elderly or disabled
>20s intervention required or needing help
How can falls be prevented?
Exercise programmes – these both reduce the number of falls and the injuries sustained from falls if they do occur.
OT assessment and modification of house to prevent falls
Assess balance – Timed up and go test - >12 seconds = increased risk
Vitamin D supplementation
How is postural hypotension diagnosed?
Measure BP in the morning lying and standing. Should be done manually and at 1 and 3 minutes post standing up. Drop of more than 20/10 with symptoms is diagnostic or a drop below 90 systolic.
Are postural and positional hypotension the same thing?
Differentiate between postural (changing your posture e.g. lying to standing) and positional (changing head position) symptoms. Postural hypotension is very common in hospital due to being dehydrated, on drugs etc. so be wary of diagnosing it whilst ill.
What causes postural hypotension?
Acute – dehydration
Medication – heart rate controlling drugs or HTN drugs or diuretics
Autonomic dysfunction e.g. in diabetes and parkinson’s
What pharmacological management can be offered for postural hypotension
Fludrocortisone – increase blood pressure by returning fluid
Fluid retention and weight gain are the common side effects – contraindicated in HF
Also watch out for hyponatraemia and hypokalaemia
Midodrine – peripheral arterial vasoconstrictor (caution in those with IHD or peripheral artery disease) Takes an hour to work and don’t lie down within 6 hours – trial for 2 weeks the review.
Describe the 4 different groups of falls?
- Group 1 – mainly locomotor, low grade balance problems, fear of falling. Very limited need for medical investigation
- Group 2 – syncope and postural hypotension
- Group 3 – neurological conditions including, PD, cerebrovascular, MSA, PSP, isolated gat apraxia, NPH and chronic subdural
- Group 4 – dementia with high risk of falls
Why is it important to rehabilitate patients after a fall?
Stop the negative cycle of increased fear of falling – inactivity – muscle weakness – increased risk of falling – falls – increased fear of falling
What general management can be given following a fall?
Home assessment and alterations
Exercises – Tai-chi
Group classes involving exercise, break fear of falling cycle
Diagnose and manage underlying conditions
Medications review – beta blockers, diabetic meds, antihypertensives, benzodiazepines, antidepressants, antibiotics (implying infection) and herbal medication
What are the risk factors for a fracture following a fall?
Female Post-menopausal CKD Steroids Smoking Age Cancers Poor diet or malabsorption e.g. coeliac disease Aromatase inhibitors and anti-epileptic drugs
What is a fragility fracture?
Fragility fracture are fracture that occur upon low impact, where a healthy bone should not have broken. Fracture risks are encompassed by the risk of falling, the force of the falls and the bone density.
