Falls ☺️ Flashcards
Describe the epidemiology of falls
30% of 65+ will fall every year
50% of 80+
60% in residential care every year
Injury rate 10-40%
Hip fracture rate 2-4% in every 100000
Describe the vicious cycle of falls
Fall
Fear of pain and falling again
Reduced activity, fitness, balance, muscle strength
Increased risk of falling with less stressful activity
How can we prevent falls
Screening
-past falls and injuries, balance problems
What are the risk factors for falls
-sociodemographic
Increased age Past falls Female Use of walking aids Inactivity
What are the risk factors for falls
- medical conditions
- medications
CV, neuro causes
Stroke Dementia/delirium PD Depression Incontinence Arthritis Foot problems Dizziness
Polypharmacy
- hypnotics/anxiolytics
- antidepressants
- antipsychotics
- antihypertensive
What are the risk factors for falls
- sensorimotor
- balance and mobility
Visual impairment
- depth perception
- contrast sensitivity
Sensory impairment
- proprioception
- vibration
- tactile
Muscle weakness
Reduced reaction times
Difficulty with sit to stand Slow walking speed Unsteady gait Unsteady when standing still Difficulty leaning or reaching
What are the risk factors for falls
- psychological
- environmental
Fear of falling
Trip hazards in the home
Stairs and uneven ground
What is dizziness
Overarching term for
- vertigo (room spinning)
- general unsteadiness (weakness)
- presyncope (feeling faint, sweaty)
May have a CV, neuro, vestibular, sensory, MSK issue
-is it associated with a specific activity or movement
How would you assess for syncope?
Falls may also be due to transient loss of consciousness
Is it traumatic or not?
Causes of non traumatic TLOC
- syncope (cardiac, reflex, orthostatic?)
- epileptic seizures (tongue biting, continence?)
- psychogenic
How would you assess for explained/unexplained syncope
Unexplained => syncope likely
-amnesia, likely to fall head first
Explained
- impaired gait
- balance
- cognitive status
- environmental hazard
- likely to fall with outstretched hands to break fall
What are the CV causes of falls
Neural
- vasovagal syncope (no input from vagus)
- carotid sinus (no feedback from carotid bodies
- orthostatic hypotension
- postprandial hypotension
- situational syncope (cough sneeze, valsalva)
Instrinsic cardiac relating to structure, rhythm
- arrythmias
- MI
- aortic dissection
- tamponade
Cerebral
- PE
- TIA/migraine
How would you do a lying and standing BP
5min lying supine
Measure BP
Stand
Measurement after 1min
Measurement after 3mins
Drop in BP due to gravity
Changed sensed in afferents (carotids, aortic arch)
Transient increase to compensate for drop Efferents via -arteriole VC -SAN increased rate -increased ventricular contractility
BP recovery within 30s
Why are older adults at increased risk of cardiogenic falls
Hypovolemia, dehydration
CVD
Autonomic impairment -baroreceptor reflex
Medication effects
What is orthostatic hypotension
-what are the consequences
Sustained BP drop on standing
- systolic BP of at least 20mmHg
- diastolic BP of at least 10 within 3mins of standing/head uptilt
Greatest risk of falls
May lead to cerebral hypoperfusion, presyncope, syncope
How does exercise alter the risks of cardiovascular causes of falls
Short term reduction in BP after exercise in hypertensive patients
Long term hypotension hours after exercise increases the risk
How might you manage reflex and orthostatic intolerance => syncope
Unpredictable or high frequency
-specific management
Predictable or low frequency
-education, reassurance and avoidance of triggers
How does age affect your vestibular apparatus , posture and balance
Neuronal and hair cell loss => affects otolith (static) and position hair cells (dynamic)
Myotatic stretch reflexes are less responsive => increased postural sway
What are the problems associated with prolonged bed rest
Prolonged periods of being horizontal resets vestibular system => increased risk of falls
What are the problems associated with visual changes
Neural and eye degeneration Decreased depth of focus Reduced light reflexes -bright light => PNS -dim light => SNS
Which brain regions are associated with falls
-what neurological disorders are implicated
Premotor cortex Supplementary motor cortex Cerebellum Occipital lobe Basal ganglia
Chronic stroke
PD
Dementia
How does sarcopenia affect the incidence of falls
Diminished muscle function, strength, power
- loss of fibre no
- fibre disuse atrophy
- decreased anabolics, increased catabolics
How may you assess someone’s risk of falls from balance, MSK, neuro problems?
Chair stand test
Balance tests
-static and dynamic
What are the 2 main components of gait
- factors that affect gait
- assessment
Timing
- steps/min
- time/distance
Sizing
- step length/stride lengths
- width
- foot angle
Neural control (CNS, PNS) Muscular - sarcopenia NMJ Skeletal (joints) Any pain?
TGUG
