Falls and Immobility Flashcards
Define Fall
Inadvertently coming to rest on the ground or other lower level without loss of consciousness and other than as a consequence of sudden onset of paralysis, epileptic seizure, excess alcohol intake or overwhelming physical force
State the percentage of people over 65 that fall
30%
State the percentage of people over 80 that fall
40%
State the number of falls that result in hip fractures
1%
List the common outcomes that can result after a fall
Injury (50%) - soft tissue, fracture, Subdural Haemorrhage etc. Rhabdomyolysis (↑CK) Loss of confidence / ‘Fear of falling’ Inability to cope Dependency / QOL Carer stress Institutionalisation Terminal decline
State the risk factors for falls
Muscle weakness, histroy of falls, gait deficit, balance deficit, visual deficit, depression, arthritis, cognitive imparimment
State the intrinsic factors as to why a patient may have a fall
Gait and balance problems, syncope, chronic disease, visual problems, acute illness, cognitive disorder, vitamin D deficiency
State the situational factors as to why a patient may have a fall
Medications, alcohol and urgency of micturition
State the medications that can increase the risk of falls
Antidepressants – TCAs > SSRIs Antipsychotics Anticholinergics/antimuscarinics Benzodiazepines Anti-hypertensives Diuretics
State the extrinsic factors that can result in falls
Inappropriate footwear, environmental hazards, poor lighting
State the different ways in which gait and balance can be assessed
Sitting to standing ability Transfers Static standing balance Romberg test Dynamic standing balance Functional reach Tandem (heel-toe) walking Timed walk Gait Tinetti gait and balance scale Berg Balance Scale ‘Get up and go’ test / timed ‘up and go’ test
state the different causes of syncope
Neurally mediated, orthostatic hypotension, cardiac arrhythmias, structural cardiac or cardio-pulmonary disease, cerebrocvascular
What is subclavian steal syndrome
Proximal stenosis of the subclavian artery
What should be asked in collateral history when trying to get to the bottom of syncope
Circumstances of the event
Posture immediately before loss of consciousness
Appearance
Presence or absence of movement during the event (?limb-jerking)
Tongue-biting
Duration of the event (onset to regaining consciousness)
Presence or absence of confusion during the recovery period
Weakness down 1 side during the recovery period.
State what should be examined for in syncope
Vital signs including lying and standing blood pressure
Focussed neurological and cardiovascular examination
Look for any injuries
How can osteoporosis risk be assessed
FRAX or QFRACTURE tool
Where is the most common site of fracture
Hip, wrist, vertebrae
How can patients with osteoporosis be treated
Calcium/vitamin D supplement, bisphosphonates, teriparatide, denosumab
State the risk factors for sarcopenia
Diabetes/Insulin resistance Elderly Chronic Disease Lack of use Inflammation Nutritional Deficiency Endocrine dysfunction
State the physical complications of immoblity
Physical Muscle wasting Muscle contractures Pressure sores Deep venous thrombosis Constipation / incontinence Hypothermia Hypostatic pneumonia Osteoporosis
State the psychological complications of immobility
Depression
Loss of confidence
State the social complications of immobility
isolation and institutionalisation
