falls and mobility impairment Flashcards
overview
-one of MC geriatric syndrome
-Older adults who report >1 fall in past year or 1 fall with injury or gait and balance problems are at increased risk for future falls and injuries
-complications after fall are leading cause of death from injury in >65yo
-Acute factors (infectious, toxic, metabolic, ischemic, or iatrogenic)
-can be a sign of medical illness and is commonly the PRESENTING symptom in older adults.
-Medications- psychotropic drugs -> increase the risk for falls.
-Common modifiable fall risk factors -> visual acuity, home environmental hazards, and footwear
falls screening
-all older adults
-annually
-ask about falls in the past year
-if there is a fall in the past year -> gait and balance eval
-2+ falls in past year or someone with gait or balance abnormality -> multifactorial falls risk assessment (thorough fall hx and PE)
hx of present illness
-Fall rates and risk of injury from falls increase with age
-Major cause of morbidity and mortality
-Major cause of nursing home placement
-Multi-factorial causes
-Independent risk factor for long term care admission
-r/o syncope
-Institutional falls:
-staff education programs
-gait training with ambulatory assistive devices
-modification of medications
general principles
mobility disorders refer to any deviation
75 year old women with ahx of htn presents to the ED via emergency medical services after sustaining fall down a flight stairs
-was there an extrinsic thing there- tripped on rug
-extrinsic vs intrinsic causes of falls
-LOC?
-find out the cause
-height
-incentive spirometry
-PFTs- increased functional residual capacity with decreased vital and total lung capacities
risk factors for falling
-previous falls
-balance impairment
-decreased muscle strength
-Can be symptom of another disease [infection or neurologic disorder, or a medication SE]
-Age-related physiologic changes contribute to fall risk
-Decreased proprioception, increased postural sway, and declines in baroreflex sensitivity resulting in orthostatic hypotension.
-Evaluation of a fall should begin with a detailed history
-PE: postural vital signs, vision evaluation, gait and balance testing, and a MSK evaluation of joint stability and ROM
-Environmental assessment of the patient’s home
assessing balance
fall prevention algorithm
management of gait and falls
-medical dx and specific tx
-assess fear of falling
-exercises, PT
-home eval
-footwear
-evaluate meds
-osteoporosis
-can person get up from fall
recommended management of modifiable risk factors
-dont wait for a fall- implement prevention prior
screening
-annual
-ask about falls and fall injuries
-ask about perception of stability
-perform brief assessment such as the get up and go test
gait assessment
-up and go test
-rise from chair, walk 10 ft, turn around, walk back, sit down
-normal < 10s
-if pt screen is + -> obtain further hx and exam
-obtain hx of onset and course of the problem
-determine assoc sx such as dizziness and pain and precipitating factors such as body position
-review meds, especially for those with effects on the central nervous system or on circulation
-examine for orthostasis, peripheral neuropathy, visual acuity and fields, motor tone, and movement
-examine speed, righting reflexes, and lower extremity strength
refer for these clinical situations
-specialist asses for specific impairments, such as visual, vestibular, or neurologic conditions
-rehab assess for gait and balance disorders, and home safety assess
-falls specialty team if problem appears to be complex and/or high multifactorial
role of primary care provider
-can implement a brief, efficient for of falls screening
-management
-detects the problem
-identifies major contributors
-implements medical adjustments
-refers for additional care
meds that can cause a fall
-AChei
-antiarrhythmics
-anticholinergics
-anticonvulsants
-antidepressents
-antihistamines
-antihypertensives
-antipsychotics
-benzos
-diuretics
-insulin and oral hypoglycemics
-narcotics
-NSAIDs
-sedative hypnotics
-glucocorticoids
