Falls and Fraility Flashcards
What is frailty?
Diminished strength, endurance and physiological function
Frailty increases a patient’s vulnerability for developing increasing dependability and morbidity when exposed to stressors.
What are the two types of frailty?
- Physical frailty
- Frailty phenotype
Physical frailty includes weight loss, exhaustion, low physical activity, slowness, and weakness; frailty phenotype includes cognitive and social frailty.
What are the clinical implications of frailty?
- High risk of falls
- Risk of delirium
- Risk of disability
- Risk of hospitalization
Frail patients often demonstrate altered pharmacokinetics and pharmacodynamics.
What are the three assessments for frailty?
- Fried Frailty index
- Groningen Frailty Indicator
- PRISMA-7 questionnaire
What are the lifestyle management strategies for frailty?
- Exercise
- Nutrition optimization
- Medication reviews
What are the two main types of falls?
- Accidental/Mechanical
- Non-accidental
Accidental falls are due to environmental or occupational factors; non-accidental falls include syncope-related and muscle weakness-related falls.
List some symptoms of a fall.
- Pain and tenderness
- Deformity
- Swelling and bruising
- Laceration and abrasion
- Mobility issues
What are some risk factors for falls?
- Anti-HTN medications
- Diabetes mellitus leading to hypoglycaemia
What investigations should be conducted after a fall?
* General health - Test hearing, vision, balance disorders, MSK, foot issues
* Blood pressure (orthostatic hypotension) - Lying/standing blood pressure
* Neurological conditions e.g. Parkinson’s
* Mental Health - assess for cognitive impairment
* Medication review - sedatives, antidepressants, antihypertensives, anti-psychotics and diuretics + medical compliance + recent changes
* Functional Ability Assessment - Motility/balance/strength - Timed Up and Go test (TUG) + Berg Balance Scale (BBS)
- Bloods - FBC (anaemia), U&Es (electrolyte imbalance)
- XR - Suspected fractures
- CT/MRI - Neurological conditions + pt. on anti-coagulants (bleeds)
- ECG - Arrythmia
- Occupational Therapy: Assessment of environment, flooring, lighting, footwear and mobility aids
What are some neurological causes of falls?
- Stroke
- Parkinson’s disease
- Multiple sclerosis
- Cerebellar disorders
What are the complications of prolonged immobility?
- **Cardiovascular issues (DVT, PE) **
- Respiratory issues (decreased lung expansion, pneumonia)
- Musculoskeletal issues (muscle atrophy, osteoporosis)
- Urinary stasis (UTIs, renal calculi)
- Gastrointestinal issues (constipation, faecal impaction)
- Psychological issues (depression, anxiety, delerium)
- Pressure ulcers
What is faecal incompetence?
Inability to control bowel movements causing stool to leak unexpectedly from the rectum.
What are the two types of faecal incompetence?
- Urge - inability to deter sensation
- Passive - involuntarry loss of stool wo/ awarness
List some causes or risks for faecal incompetence.
- Diarrhoea
- Constipation
- Muscle/nerve damage
- Childbirth
- Ageing
- Diseases (e.g., diabetes, stroke)
What investigations are used for faecal incompetence?
- Digital rectal examination (DRE)
- Endoscopy
- Manometry
- Ultrasound
- Nerve conduction study
What defines constipation?
Infrequent stools (< 3 times weekly), difficult stool passage, or seemingly incomplete defecation.
What are the types of constipation?
- Functional
- Medication-induced
- Irritable bowel syndrome with constipation (IBS-C)
What are some investigations for constipation?
- Digital rectal examination (DRE)
- Blood tests (FBC, coeliac serology)
- Stool tests
- Imaging (abdominal X-ray, colonic transit study)
What complications can arise from constipation?
- Overflow diarrhoea
- Acute urinary retention
- Haemorrhoids
What management strategies are recommended for constipation?
- Active lifestyle
- Proper toilet habits
- High fibre diet
- Adequate fluid intake
What are some key drugs in polypharmacy for multi-morbidity?
- Bisphosphonates
- NSAIDs
- Warfarin
- Aspirin
- Nephrotoxic drugs
What is the STOPP-START Criteria?
Guidelines outlining drugs to consider removing in elderly patients with dementia.
What is the recommendation for medication review in patients over 65?
Yearly review of all medications.
What are the different types of laxiatives?
- Bulk-forming: increases faecal mass –> triggers stretch receptors to promote peristalsis e.g. Ispaghula husk/Sterculia
-
Osmotic laxatives: Increases water content in bowel lumen promoting bowel movement –> lactulose/Macrogols
* Stimulant laxatives: Increases intestinal motility by direct action on enteric nerves/smooth muscle –> Senna/bisacodyl
