falls Flashcards
how are falls classified
syncopal v non syncopal
non syncopal causes falls
Falls Cataplexy Drop attacks Psychogenic pseudo-syncope Transient ischaemic attacks (TIA) of carotid origin
Metabolic disorders, including hypoglycaemia, hypoxia, hyperventilation with hypocapnia
Epilepsy
Intoxications
Vertebro-basilar transient ischaemic attack
groups at risk of falling
all patients aged 65 years or older
patients aged 50 to 64 years who are judged by a clinician to be at higher risk of falling because of an underlying condition.
intrinsic risk factors of falling
- Lower limb muscle weakness
- Vision problems
- Balance/gait disturbances (diabetes, rheumatoid arthritis and parkinson’s disease etc)
- Polypharmacy (4+ medications)
- Incontinence
- > 65
- Have a fear of falling
- Depression
- Postural hypotension
- Arthritis in lower limbs
- Psychoactive drugs
- Cognitive impairment
why do we DO lying and standing BP
orthostatic hypotension
what is the timed up and go test
determine fall risk and measure the progress of balance, sit to stand and walking
what are the cut off scores to indicate risk of falls
take more than 12 seconds
Community dwelling adults - 13.5 Older stroke patients - 14 Frail elderly - 32.6 LE amputees - 19 PD - 11.5 Hip OA - 10 - Vestibular disorders - 11.1
falls history include what
What were they doing?
- standing orthostatic hypotension
- exercising - MI
- sitting.lying - seizure
- eating - postprandial hypotension
- toilet, cough, pain, fear - vasovagal
How did the fall happen? How did they feel before the fall? - palpitations - AF, arrythmia or vasoavgal - chest pain - MI - gustatory or olfactory aura - seizures
Was there and dizziness or a lightheaded feeling?
- hypotension
Did they lose consciousness?
Did they have any cardiac symptoms? Are they weak anywhere? Has this happened before? Have they had any near misses before? What medicaion do they take? Think sedaives, cardiac medicaions,anicholinergics, hypoglycaemics, opiates that can contribute to falls. How do they normally mobilise?
what examination should they focus on in falls pt
A functional assessment of their mobility – how do they mobilise, what with and
what is their gait like, use of walking aids and hazard appreciation
Cardiovascular examinaion – include an ECG and a lying and standing BP (at
immediate, 3 and 5 minutes), pulse rate and rhythm. listen for murmurs esp aortic stenosis
Neurological examination - identify stroke, parkinsons, peripheral neuropathy, vestibular, myelopathy, cerebellar degeneration and cognitive impairment
Musculoskeletal examination – assess their joints, assess footwear.
- assess for defromity, instability or stiffness
vision
define a fall
person non-intentionally coming to rest at a lower level (usually the floor) with or without loss of consciousness.
Adverse consequences of falls in elderly people
- Multiple system impairments which lead to less effective saving
mechanisms. Falls are more frightening and injury rates per fall are higher
• Osteoporosis and increase fracture rates
• 2° injury due to post-fall immobility, including pressure sores, burns,
dehydration, and hypostatic pneumonia.
• Psychological adverse effects, including loss of confidence
drugs that cause postural hypotension
nitrates diuretics anticholinergic medications antidepressants beta-blockers L-Dopa ACE inhibitors
Ix for falls
Bedside tests - basic obs, BP, glucose (hypoglycaemia), urine dip (infection) and ECG
Bloods - Full Blood Count, Urea and Electrolytes, Liver function tests and bone profile, B12, folate, glycosylated Hb (HbA1c), calcium, phosphate, TFT
• Vitamin D—deficiency is common in older adults, and evidence suggests
that replacing may reduce falls/harm from falls
imaging
Xray of chest/injured limbs, CT head and cardiac echo
- 24h eCG in a patient with frequent near-syncope and a resting eCG
suggesting conducting system disease
• echocardiogram in a patient with systolic murmur and other features
suggesting aortic stenosis (e.g. slow-rising pulse, (LVH) on ECG)
• Head-up tilt table testing (HUTT) in patients with unexplained syncope,
normal resting ECG, and no structural heart disease
• Carotid sinus massage
what information and support should be give to someone at risk of falling 50-64
- explain to the pt individual risk factors for falling in hospital
- showing the patient how to use the nurse call system and encouraging them to use it when they need help
informing family members and carers about when and how to raise and lower bed rails - providing consistent messages about when a patient should ask for help before getting up or moving about
- helping the patient to engage in any multifactorial intervention aimed at addressing their individual risk factors.
multifactorial assessment includes what
- identification of falls history
assessment of gait, balance and mobility, and muscle weakness - assessment of osteoporosis risk
- assessment of the older person’s perceived functional ability and fear relating to falling
- assessment of visual impairment
- assessment of cognitive impairment and neurological examination
- assessment of urinary incontinence
- assessment of home hazards
- cardiovascular examination and medication review.
