Falls and Balance Disorders Flashcards
How common are falls?
- 1/3 of people 65+ will fall 1+ x per year
- incidence increases with age, 50% people 85+ fall 1x per year
What are the consequences of falls?
- Leading cause of injury>hospital admission in 65y+
- 4% admissions, 1% deaths 65+
- 50% falls have injury, 10-15% serious
- 5% #, 1% hip #
- fear of falling
What are the types of factors which contribute to an individual’s risk of falling?
- Intrinsic: individual and their health
- Extrinsic: environment
- Behavioural: interaction b/w person and environment
What are the types of intrinsic factors relevant to falls?
- Medical conditions affecting vision, musculoskeletal, neurological and CV systems.
- drugs (esp psychoactive and CV)
What are the extrinsic factors relevant to falls?
- Personal environment factors: inappropriate footwear, clothing, mobility aids
- domestic environment factors: poor lighting, loose rugs, slippery floors, clutter
- Behavioural: risky activities e.g. ladder climbing, standing on a chair
What are the main mechanisms for falling?
- slip or trip
- collapsing w/o LOC (legs give way)
- overbalancing
- dizziness
- LOC
What is required for the body to remain upright?
- take information about position of body relative to surroundings
- integrate and process
- make adjustments in body position in space by contracting and relaxing large muscle groups
How is sensory information about body positioning gathered?
- eyes
- inner ear (vestibular system)
- pressure and joint position sensory in neck, turn and lower limbs (somatosensory system)
What are the commonly used balance tests?
- Romberg’s
- TUG
- Standing on heels or toes
- Sternal push or shoulder tug (Paster’s test)
- Functional reach
- Hallpike manoeuvre (for dizziness)
What are the principles of falls prevention?
- Identify factors contributing to overall risk of falling
- determine factors amenable to intervention
- determine interventions acceptable to patient
- involve allied health
How can intrinsic factors be managed in falls prevention?
- improve med conditions contributing to risk of falling (vision, Rx, post hTN, joint conditions, syncope Mx)
- consider exercise programs to improve strength, flexibility, endurance and balance
How can extrinsic factors be managed in falls prevention?
- Appropriate foot care and advice re safe footwear
- appropriate gait aids (SPS, 4WF)
- home hazard assessment
How can behavioural factors be managed in falls prevention?
- health professional advice
- psych/behaviour modification for severe fear of falling
Strategies to prevent falls injuries?
- Hip protectors (proven benefit in residential facilities only)
- Advice on how to get up from the floor (prevent complications of long lie)
- osteoporosis Rx / Vit D supplementation if deficient
How is the TUG performed?
Patient stand from seated in chair, walk for 3m, turn, return to chair and sit
