Falls and Fractures Flashcards
What percentage of adults over 65 experience falls in the UK?
34%
What is the estimated annual cost of falls in the UK?
£4.4 billion
Where are falls more common in older adults?
Care homes and hospital settings
What is a major consequence of falls in the elderly?
Accelerated loss of independence
How many hip fractures occur annually in the UK?
70,000–75,000
What is the estimated cost of hip fractures per year?
£2 billion
What health condition doubles the risk of recurrent falls?
Frailty
What is the key feature of frailty?
Sarcopenia (loss of muscle mass)
Name 5 intrinsic risk factors for falling.
Gait disturbance, vestibular dysfunction, impaired cognition, sensory loss, chronic illness (e.g. Parkinson’s)
What psychological factor increases fall risk after a previous fall?
Fear of falling
How many medications (polypharmacy) increase fall risk?
Four or more
List some medication classes that increase fall risk.
Hypnotics, anticholinergics, antihypertensives, opiates, hypoglycaemics, cardiac meds (diuretics, rate-limiters)
What is the issue with the term “mechanical fall”?
It usually reflects underlying frailty, not purely mechanical causes.
What are recurrent falls usually due to?
Frailty with a mix of intrinsic and extrinsic factors.
What might sudden increased fall frequency suggest?
An underlying acute medical condition (e.g. infection).
Name 5 immediate medical complications of a fall.
Fractures, head injury, lacerations, dehydration, pneumonia
What is a “long lie”?
Lying on the floor for an extended period after a fall, leading to complications like AKI or hypothermia.
What are the 3 key features of fall prevention guidelines?
Risk stratification, assessment, management/intervention
What type of assessment is recommended for older adults with recurrent falls or gait imbalance?
Multifactorial falls risk assessment
Multifactorial risk assessment includes:
Gait/balance/muscle weakness
Osteoporosis risk
Visual and cognitive function
Urinary incontinence
Medication review
Cardiovascular exam
Home hazards
Fear of falling
What is the purpose of a Comprehensive Geriatric Assessment?
Holistic approach to assess functional, medical, cognitive, and social domains.
Name 4 difficulties in falls-related research.
Poor quality evidence, under-reporting (esp. men), small samples, lack of blinding
What is osteoporosis?
A condition of low bone mass and structural deterioration leading to bone fragility.
What test diagnoses osteoporosis?
DEXA scan (dual-energy X-ray absorptiometry)
What is the diagnostic T-score for osteoporosis?
T-score of ≤ -2.5
What T-score range defines osteopenia?
T-score between -1.0 and -2.5
What is a fragility fracture?
A fracture resulting from a low-level trauma due to osteoporosis.
What are common sites of osteoporotic fractures?
Wrist, hip, spine; also ribs, pelvis, humerus
What maintains normal bone strength?
Balance between bone resorption (osteoclasts) and deposition (osteoblasts)
What hormone is key in maintaining bone mass?
Oestrogen
Name two other contributors to bone weakening.
Cytokines and prostaglandins
Name 5 risk factors for osteoporosis.
Older age, female sex, smoking, alcohol, early menopause, low BMI, corticosteroid use
What two risk calculators are commonly used?
FRAX and QFracture
FRAX and QFracture
NOGG (National Osteoporosis Guideline Group)
What labs should be checked?
Vitamin D, calcium levels
What is first-line treatment for osteoporosis?
Bisphosphonates (e.g., alendronate)
What is an alternative to bisphosphonates?
RANK-L inhibitor (denosumab)
What therapy can be considered in early menopause?
HRT (with caution due to breast cancer risk)
What should be ruled out in pathological fractures?
Malignancy
What are 4 key approaches to prevention?
Opportunistic case finding
Education for patients and carers
Encourage physical activity
Use of osteoporosis risk tools in those at risk of falls
Name 3 weaknesses in fall-risk research studies.
Small sample sizes
Reporting bias
Lack of blinding
External validity issues
