Falls and Hip Fracture

Question 1

What are 10 risk factors for falls?

Answer 1

1. Previous falls
2. Fear of falling
3. Balance problems
4. Gait/mobility problems
5. Pain
6. Medications
7. CV conditions/syncope
8. Cognitive impairment
9. Urinary incontinence
10. Stroke
11. Diabetes

Question 2

What defines LTC patient as high risk for fracture?

Answer 2

1. Prior hip or spine #
2. > 1 prior fracture
3. Recent use of systemic steroids and 1+ prior fracture
4. Vertebral fracture
5. ID’d as high risk or on OP tx before LTC

Question 3

Recommendations for LTC patients regarding bone health/falls

Answer 3

Screen all residents on admission and when #/fall occurs
Do not use physical restraints for falls prevention

All residents
1. Ca 1200 mg, Vit D 800-2000 IU
2. Hip protectors if mobile
3. Multifactorial Fall prevention strategies
a. exercise (strength, balance, functional)
b. med review (Beers)
c. environmental review
d. assistive devices
e. manage UI

High risk and expected to live 1+ yr
1. Bisphosphonates
2. Denosumab if CrCl 15-30
Alendronate, risedronate, denosumab or ZA if no dysphagia, suggest teriparatide

Question 4

4 acute or chronic joint related complications of ORIF for acute intertrochanteric fracture?

Answer 4

1. Joint dislocation
2. Cut out
3. AVN
4. Malunion of the joint

Question 5

Risk of anticoagulation in patient who frequently falls

Answer 5

Need to fall 295 times/yr for risk of SDH to outweigh benefit of anticoagulation for stroke prevention
?only applies to warfarin though

Question 6

5 components of an exercise program for falls prevention

Answer 6

1. Balance exercise (side step)
2. Functional exercise (sit to stand)
3. Strength based
4. Multicomponent exercise
5. Tai Chi

Question 7

What are 5 things on screening that would make you want to do a comprehensive falls assessment?

Answer 7

If history of fall in the last year…
1. Injury
2. 2+ falls in last year
3. Frailty
4. Lying on floor/couldn’t get up
5. LOC/syncope

Question 8

What are three screening questions/key questions for falls risk?

Answer 8

1. Fall in last year?
2. Feel unsteady when standing or walking?
3. Worries about falling?

Question 9

Cochrane 2018 interventions for preventing falls in LTC

Answer 9

1. Uncertain on effect of exercise on rate, little or no diff for risk
2. General medication review little or no diff rate or risk
3. Vit D supporte probably reduces rate of falls but not risk of falling
4. Uncertain multifactorial interventions on rate, little or no diff risk

Question 10

Cochrane 2018 interventions for preventing falls in hospital

Answer 10

1. Uncertain additional PT on rate or risk
2. Uncertain bed sensor on rate or risk
3. Multifactorial may reduce rate

Question 11

World falls guidelines algorithm

Answer 11

Question 12

According to World Falls Guidelines what broad domains should be assessed in multifactorial falls risk assessment?

Answer 12

1. Disease history
2. Medication history
3. Environmental Risk
4. Cognitive function
5. ADL
6. Mobility
7. Autonomic function
8. Sensory function
9. Nutritional history

Question 13

Cochrane 2019 exercise type to prevent falls

Answer 13

1. Multicomponent
2. Balance and functional
3. Tai chi

Question 14

What are 5 risk factors identified for hip fracture in LTC resident?

Answer 14

1. Ability to walk in a corridor
2. Ability to transfer
3. Low BMI
4. Wandering
5. Fall in last 30 days
6. Fall in last 180 days
7. CI
8. Age >85