Falls and Incontinence Flashcards
1
Q
History for falls
A
- What were they doing?
- How did fall happen?
- How did they feel before the fall?
- Was there any dizziness or lightheaded feeling?
- Did they lose consciousness?
- Cardiac symptoms?
- Weak anywhere?
- Happened before?
- Near misses?
- Medications - sedatives, cardiac meds, anticholinergics, hypoglycaemics, opiates
- How do they normally mobilise
2
Q
Examination following fall
A
- Functional assessment of mobility - how do they mobilise, what with and their gait
- CVS exam - inc ECG, lying and standing BP (immediate, 3 and 5 mins)
- Neurological exam
- MSK exam - assess joints
3
Q
3 fall risk assessment tools
A
- Falls risk assessment tool (FRAT) - 4 domains (recent falls, medications, psychological cognition)
- Timed up and go test (TUG)
- Berg balance scale
- Balance outcome measure for elder rehabilitation (BOOMER)
4
Q
Risk factors for osteoporosis
A
- Age (between 40 and 90 years)
- Gender (female)
- Previous fracture
- Parent fractured hip
- Smoking
- Glucocorticoids (more than 3 months at a dose of prednisolone 5mg daily)
- Rheumatoid arthritis
- Secondary osteoporosis - hyperthyroid/parathyroidism, alcohol abuse, immbobilisation
- Alcohol consumption
- BMD
5
Q
Medications used to treat osteoporosis
A
- Calcium and vitamin D supplementation
- Oral bisphosphonates eg Alendronate, risedronate (weekly)
- IV infusion bisphosphonate - zoledronic acid (yearly)
- Denosumab - SC every 6 months
- HRT if early menopausal women
6
Q
Risks of bisphosphonates
A
- Oesophagitis
- Careful monitoring if CKD 4/5
- Osteonecrosis of jaw
- Atypical stress fracture
- Hypocalcaemia
- Bone/joint pain
- Diarrhoea
- Nausea
- Lack of strength/energy
- Fever/flu symptoms (esp if IV infusion)
7
Q
Denosumab side effects/risks
A
- Dysuria
- Cellulitis
- Osteonecrosis of the jaw
- Hypocalcaemia
- Unusual thigh bone fracture (atypical stress fracture)
- Infections - skin, abdomen, endocarditis
8
Q
What is polypharmacy?
A
6 or more drugs prescribed at one time
9
Q
Check word doc with medications that are in workbook and completed table
A
Know the table
10
Q
Why is incontinence a problem?
A
- Major factor leading to falls
- Can contribute to needing 24hr care
- Common - 30% people home, 50% residential have incontinence - NOT PART OF NORMAL AGEING
- Impact on mental health and wellbeing
11
Q
Examinations for incontinence
A
- Abdominal exam
- PR exam inc prostate assessment in male
- External genitalia review - look for atrophic vaginitis in females
12
Q
Investigations for incontinence
A
- Bladder and bowel diary - minimum 3 days
- QOL questionaire eg ICIQ
- MSU dipstick and culture
- Post void bladder scan - especially if ?overflow
- Urodynamic studies if still unclear
- Cystoscopy
- IV urogram
- Sometimes MRI
13
Q
Management stress incontinence
A
- Pelvic floor exercises - 8 contractions, 3x per day, min 3 months
- Surgical procedures eg retropubic mid urethral tape procedures/tension free vaginal tape, colposuspension, intramural bulking agents, artifical urinary sphincter
- Pharmacological if not want surgery - Duloxetine
14
Q
Management urge incontinence
A
- Bladder retraining (min 6 weeks)
- Antimuscarinics eg oxybutynin or tolterodine (Avoid Oxybutynin in frail older women)
- Mirabegron if concerned re anticholinergic side effects in frail older people
- Surgery - botulinum toxin A injections, percutaneous sacral nerve stimulation, augmentation cystoplasty (bowel into bladder wall to increase size), urinary diversion via ileal conduit
15
Q
Lifestyle advice for all incontinence
A
- Weight loss
- Reduce caffeine intake
- Smoking cessation
- Avoid drinking excessive volumes of fluid
- Good bowel habits
- Regular toileting
17
Q
Drugs used to treat incontinence, their class and side effects
A
18
Q
Anticholinergic side effects
A
