Falls and Frailty Flashcards
What is the WHO definition of a fall?
An event which results in a person coming to rest inadvertently on the ground or floor, or other lower level.
Give 5 potential adverse outcomes from a fall
Fear of falling- anxiety, limits daily activities Social isolation Injuries and fractures Death Carer strain Institutionalisation Depression and anxiety
Give 4 environmental and 4 intrinsic risk factors for falls
Environmental= rugs, poorly fitted slippers, over polished floors, walking sticks, poor lighting, polypharmacy
Intrinsic= Parkinson’s, diabetes, thyrotoxicosis, heart problems, stroke/TIA, cognitive impairment, osteoartritis, cataracts
Give the 5 systems that work together to maintain upright posture
Vision Proprioception Vestibular system Brain cortex Effector mechanisms- muscles
What is the triad of falls prevention?
Strength and balance training
Environmental assessment
Medical Assessment
How can strength and balance training help to prevent falls?
Physiotherapist makes an assessment
Tailor made therapy course aimed at improving strength and balance- eg. pilates, Tai Chi, grip strength
At least 50 hours of training should be done
How can an environmental assessment help to prevent falls?
OT assesses the home environment and any potential hazards. They will suggest improvements and can provide assistive equipment.
Eg. bath aids, dressing aids, grab rails, raised toilet, stair lift, remove camouflage carpets hard to visualise individual steps)
How can a medical assessment help to prevent falls?
- Diagnose any new medical conditions that have presented as a fall
- Optimise management of comorbidities
- Bone health assessment + add in Ca2+/vit D
- Medication review using STOPP/START toolkit
What is the STOPP/START toolkit and what drugs may fall into each category?
STOPP= drugs potentially inappropriate in patients aged >65 years eg. Digoxin, Warfarin, Furosemide, NSAIDs, Oestrogens, TCAs, antipsychotics
START= drugs that could be considered in patients aged >65 years eg. Fibre supplements, Ca2+, vitamin D, aspirin, ACEi, levodopa, antidepressants, metformin, bisphosphonates
How can these people manage and prevent falls:
- GP
- Institutional carers
- Inpatient staff
- Emergency department
- GP = opportunistic falls assessments
- Institutional carers= reduce hazards, increase exercise, regular reviews, low threshold to get GP review
- Inpatient staff= refer for falls assessment even if unrelated admission, OT/PT discharge, bone assessment
Emergency department= A-E, look for medical cause of fall, treat any fall related injuries
What is the definition of frailty?
A state associated with low energy, slow walking speed and poor strength. Associated with increased age and multiple comorbidities.
State of increased vulnerability due to poor resolution of homeostasis after a stressor event such as a fall, UTI, ED admission or a change in medication. May never return to their baseline level and will have a slow recovery.
Higher risk of hospital admission, care home admission and death
Give the 5 factors involved in the ‘Frailty Phenotype’
Unintentional weight loss Reduced muscle strength Reduced gait speed Self reported exhaustion Low energy expenditure
1-2 = pre-frail 3= frail
What is the Rockwood-Cumulative Deficit Model of Frailty?
Assesses frailty based on accumulation of various deficits such as hearing, vision, tremors and diseases like diabetes. Proven to identify risk of hospital admission, care home admission and death.
What is the electronic Frailty Score?
Based off the Rockwood-Cumulative Deficit Model of Frailty
Searches the GP records for 36 variables to give a frailty score where the max is 0.7. Frail if score above 0.36.
Very accurate but requires good clinical knowledge of the patient.
What is the clinical frailty score?
Pictorial score of assessing frailty based on mobility and exercise
What is the FrailSafe score?
Score for inpatient use to assess frailty
3 questions:
- Are they confused?
- Do they live in a care home?
- Do they have reduced mobility?
If yes to any answer do the full FrailSafe questionnaire.
What 3 tests can be done to physically assess frailty?
Gait speed (<0.8m/second)
Grip strength
Timed up and go test (>12 seconds)
Give examples of 4 patient groups who should be assessed for frailty
> 85 years old
Living in nursing home
Polypharmacy
Patient with a frailty syndrome= fall, delirium, dementia, immobility, incontinence, end of life
What is the Comprehensive Geriatric Assessment (CGA)?
Multidimensional holistic assessment of an older person which considers health and wellbeing. Leads to formation of a plan to address issues which are of concern to the older person.
Interventions then arranged and progress is reviewed regularly.
Proven to reduce mortality, improve independence, reduce hospital admissions and reduce frailty.
Can be done by a GP, nurse, pharmacist or community geriatrician
What physical examinations can be carried out as part of the Comprehensive Geriatric Assessment (CGA)?
Sensory –> hearing test, vision testing
Feet –> suitable footwear, skin, nails, ulcers, ischaemia, cap refill, peripheral neuropathy, pulses, warmth
Balance and gait –> timed up and go
Lying and standing BP
Cognition and mood –> GCS, vocab, ability to recall info
Functional ability
Weight and nutrition
Other –> constipation, continence, comorbidities
What functional assessments can be carried out as part of the Comprehensive Geriatric Assessment (CGA)?
- What can the patient do?
- Any change in functional ability recently?
Barthel’s Score –>
Assesses feeding, bathing, grooming, dressing, toilet use, bladder, bowels, transfers, mobility and stairs
What social history can be taken as part of the Comprehensive Geriatric Assessment (CGA)?
- Who do they live with?
- What support do they have?
- Do they go out? - driving, mobility, public transport
- Capacity, safeguarding, DOLs, LPA, IMCA
- Accomodation quality- heating, stairs, equipment
How can Mobility and Balance be assessed as part of the Comprehensive Geriatric Assessment (CGA)?
History= any recent falls? current walking ability? timescale in reduction of mobility? prior interventions?
Examination = Gait abnormalities, timed up and go test, 180 degree turn test, gait speed
How can mood and cognition be assessed as part of the Comprehensive Geriatric Assessment (CGA)?
- Screen for depression in the elderly- can lead to poorer outcomes
- Cognitive impairment- presents with forgetfulness, test with GPCOG, AMTS or MMTS
What is done in a medication review?
Obtain full list of medications including over the counter and herbal/alternative
Review concordance, appropriateness, side effects and any interactions
Any changes should be done slowly and any additions should be done 1 at a time
