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Y3M - Older Persons Medicine > Falls > Flashcards

Falls Flashcards

1
Q

What is mechanical fall?

A

This term is not used.

This is because all falls are mechanical, it used to be a conclusion of exclusion but is not used.

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2
Q

History of fall.

A

What were they doing?

How did the fall happen?

How did they feel before the fall?

Was there any dizziness or a lightheaded feeling?

How did they feel after the fall?

Did they lose consciousness?

Did they have any cardiac symptoms?

Are they weak anywhere?

Has this happened before?

Have they had any near falls before?

Medication?

How do they normally mobilise?

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3
Q

What medications are important to consider in a fall?

A

Sedatives

Cardiac medications like antiarrhythmics and hypotensives.

Anticholinergics

Hypoglycaemics

Opiates

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4
Q

Examination of a fall.

A

Functional assessment of mobility - How do they mobilise, do they need aid, what is their gait?

CVS examination + ECG and lying and standing BP (immediate, 3 and 5 minutes)

Neurological examination

MSK examination + joint assessment.

Abdominal - constipation and urinary incontinence

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5
Q

Intrinsic and optimisable risk factors for falling.

A

Concurrent illness

Cardiac syncope

Medications

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6
Q

Intrinsic and static risk factors of falling.

A

Weakness from previous stroke

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7
Q

Extrisinc and optimisable risk factors for falling.

A

Trip hazards

Grab rails

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8
Q

Extrinsic and static risk factors of falling.

A

Stairs into the house

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9
Q

Give example of risk factors for falls.

A

Unsteady gait

Leg weakness

Peripheral sensory impairment

Joint instability

Pain

Cerebrovascular disease

Cognitive impairment

Depression

VIsual impairment

Hearing impairment

Medication/polypharmacy

Postural hypotension

Electrolyte imbalances

Anaemia

Urinary incontinence

DM

Brady and tachyarrhythmias

Fear of falling

Vertigo like BPPV

Foot health

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10
Q

Investigations of falls.

A

Bloods - FBC, crea and U&Es, Glucose/HbA1c, Bone profile and Vit D, TFT, B12 etc…

ECG

CXR

Possible CT head if trauma to head

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11
Q

How can falls be categorised?

A

Into syncopal and non-syncopal falls.

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12
Q

5 I factors of falls.

A

Immobility

Instability

Incontinence

Iatrogenesis

Intellectual impairment

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13
Q

What is the main cause of falls?

A

Medications such as;

Vasoactive

Psychoactive

Statins

Steroids

Hypoglycaemic agents

Anti-histamines

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14
Q

Define syncope.

A

A transient loss of consciousness due to inadequate cerebral blood flow.

In lay-term = faint

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15
Q

Give types of syncope.

A

Vasovagal syncope

Postural (orthostatic hypotension)

Postprandial hypotension

Micturition syncope (while passing urine)

Carotid sinus syncope (tight collar, looking upwards, turning head)

Cough syncope

Obstructive - aortic stenosis, myopathy, pulm stenosis, pulm HTN/E, atrial myxoma

Arrhythmias

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16
Q

What is the most common syncope?

A

Vasovagal syncope

17
Q

Explain vasovagal syncope.

A

Also called neurocardiogenic syncope.

It is a simple faint due to peripheral vasodilation and venous pooling of blood.

This leads to a reduction in the amount of blood returned to heart.

The near-empty heart responds by contracting vigorously, this leads to stimulation of mechanoreceptors in the inferoposterior wall of the left ventricle.

These in turn will trigger reflexs via the CNS to reduce ventricular stretch. This can cause further vasodilation and bradycardia.

This drops blood pressure and therefore the syncope.

18
Q

Prodromal symptoms of vasovagal syncope.

A

Dizziness

Nausea

Sweating

Tinnitus

Yawning

Sinking feeling

19
Q

Prodromal symptoms of a cardiac-related syncope.

A

Chest pain

Palpitations

Dyspnoea

20
Q

Prodromal symptoms of a CNS related syncope.

A

Aura

Headache

Dysarthria

Limb weakness

21
Q

Non-cardiac related causes of syncope.

A

Dehydration

Intense emotional stress

Anxiety

Fear

Pain

Hunger

Use of alcohol or drugs

CNS - TIA, Stroke, Seizure

22
Q

What is situational syncope?

A

Situational syncope is a type of vasovagal syncope. It happens only during certain situations that affect the nervous system and lead to syncope. Some of these situations are:

Dehydration

Intense emotional stress

Anxiety

Fear

Pain

Hunger

Use of alcohol or drugs

Hyperventilation (breathing in too much oxygen and getting rid of too much carbon dioxide too quickly)

Coughing forcefully, turning the neck, or wearing a tight collar (carotid sinus hypersensitivity)

Urinating (miturition syncope)

23
Q

How can non-syncopal falls be classified?

A

Disorders without any loss of consciousness

Disorders with partial or complete loss of consciousness

24
Q

Give causes of nonsyncopal falls without LOC.

A

Falls/trips

Weakness in legs

Joint instability

Pain

Peripheral neuropathy

Visual impairment

Cataplexy

Drop attacks

Psychogenic pseudo‐syncope

Transient ischaemic attacks (TIA) of carotid origin

25
Q

Give causes of nonsyncopal falls with partial or complete LOC.

A

Metabolic disorders, including hypoglycaemia, hypoxia, hyperventilation with hypocapnia

Epilepsy

Intoxications

Vertebro‐basilar TIA

etc…

26
Q

Causes of loss of consciousness diagram.

A
27
Q

Treatment of falls.

A

Treat underlying cause.

Medication review.

Treat any reversible cause.

Consider bone health by FRAX tool

MDT review with physio, occy health and referrals

28
Q

Interventions in fall.

A

Strength and balance training

Home hazard intervention

Correct vision

Modification and withdrawal of medication

Integrated management of contributing morbidities

Consider barriers to change like fear and patient preference.

29
Q

Consequences of falls.

A

Fear of subsequent falls

Fragility fractures

Neck of femur fractures

Institutionalisation

30
Q

Explain fear of falling.

A

Even after a minor fall without any injuries a patient might develop fear of falling.

This is characterised by anxiety around mobilising and is associated with an increasing loss of confidence and hesitant gait.

This leads to an increased risk of falling, due to hesitant gait, lack of movements due to anxiety leading to sarcopenia and weakness.

It can also cause social isolation and depression further increasing the risk of falls and the consequences of falls.

31
Q

What are fragility fractures?

A

Occur when an injury from a standing height or lower.

It ranges from vertebral fractures to wrist, proximal humeral, pubic rami and NOF fractures.

They are commonly associated with osteoprosis and needs further investigation.

32
Q

Causes of acute postural hypotension.

A

Reduced intravascular volume such as;

Decreased oral intake

Excessive diuresis

Diarrhoea

Vomiting

Haemorrhage

33
Q

Chronic causes of postural hypotension.

A

Medications - diuretics, b-blockers and other antiarrhymtics, antihypertensives and vasodilators.

Autonomic dysfunction associated with DM, Parkinson’s, multisystem atrophy.

Poor vascular compliance seen in ageing blood vessels due to a reduction in elasticity and increased calcification.

34
Q

Explain measurement of postural BP.

A

Ensure that patient is able to stand.

Use a manual ideally.

Lie patient down for 5 minutes.

Measure BP.

Stand patient up and measure straight away.

Wait 3 min and measure again.

Wait to a max of 5 min total and do it again.

35
Q

Definitions of signficant drop in BP in postural hypotension.

A

Classic - reduction of 20/10 mmHg within 3 min of standing

Initial - Reduction of 40/20 in first 15 sec.

Delayed - No agreed definition but occurring after 3 min

36
Q

Management options in postural hypotension.

A

Review medications

Treat underlying cause

Abdominal binders

Bolus of water

Bed elevation

Counter-manoeuvres

Drugs like fludrocortisone and midodrine

Education

Exercise

Fluid intake

Y3M - Older Persons Medicine (8 decks)

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