Falls and multimorbidity Flashcards
what is bipedality? what does this mean?
- using 2 feet
- how adults walk
- makes humans inherently instable
what is a fall?
- sudden, unintentional change in position, which causes an individual to land at lower level, on an object, the floor, or the ground
what is a fall a result of?
- sudden onset of paralysis, epileptic seizure or overwhelming external force
what is balance?
- ability to maintain equilibrium and orientation with the centre of gravity over the base of support
what are the 10 factors that contribute to the maintenance of balance?
- vision
- vestibular function
- blood pressure
- sensation
- central processing
- heart rate
- joint stability
- proprioception
- balance
how does vision contribute to balance?
- feedback tells you the alignment of your body in the environment
what is vestibular function? what does it tell you?
- inner ear
- tells you where your head is in alignment with the rest of the body and space
how is blood pressure involved in maintaining a normal position?
- hypertension causes low blood to the brain
how does muscle strength contribute to frailty?
- weak muscles causes limited movement
how does sensation aid in the maintenance of a normal position?
- ensures good balance, force and stabilisation
what is central processing?
- brain’s ability to receive, interpret, manipulate and respond to info
when would heart rate negatively affect normal position?
- when it is uneven or irregular
- causes inadequate supply of blood to the head
how many over 65s fall at least once per year?
- one third of over 65s
how many age 80 and above fall at least once per year?
- half of those aged 80
what is the most common cause of injury related deaths in over 75s?
- falls
how many people have osteoporosis in the UK?
- over 3 million people
how many hip fractures occur every year in England?
- 75,000 hip fractures
what percent foes falls and instability account for nursing home admissions?
- 40%
what is the total annual cost of fragility fractures to the UK been estimated at? what does this include? how much of this is for hip fractures?
- estimate at £4.4 billion
- includes £1.1 billion of social care
- hip fractures account for £2 billion of this sum
how much does unaddressed fall hazards cost the NHS in England?
- costs the NHS £435 million
how many hip fracture patients entered long term care in the first year after fracture?
- around 20% of hip fracture patients
how many dementia patients have a fall?
- 60% of people with dementia will fall
what is the death like of care home residents with hip fractures?
- 35 to 55% die within 6 months
- 62% die within 2 years
how many care home residents fall each year?
- 30%
what is the median survival for those treated surgically vs non- surgically for hip fractures?
- those treated surgically is approx. 1.4 years
- those treated non- surgically is approx. 0.4 years
what are the 14 physical consequences of falling?
- muscle wasting
- death
- sprains and strains
- immobility
- incontinence
- fracture
- soft tissue injuries
- pneumonia/ chest infection
- head injuries
- dislocations
- pressure sores
- dehydration
- lacerations
- hypothermia
how would someone get hypothermia from falling?
- if someone falls in the garden and are unable to get back up then they are in the same position for a prolonged period
what are the 12 psychological effects?
- increased dependency
- emotional distress
- loss of control
- social isolation
- withdrawal
- fear of further falls
- low self esteem
- embarrassment
- anxiety
- depression
- carer stress
- feelings of uselessness
what are the 9 intrinsic risk factors?
- history of falls
- fear of falling
- age related changes
- medication side effects
- poor vision
- weakness
- gait deficit
- hearing impairment
- cognitive impairment
how does history of falls increase risk of falling?
- if fall was within 6 months then the patient it likely to fall again
what are some age related changes that would contribute to falling?
- osteoporosis
- menopause
- sarcopenia
what are some medication side effects that can contribute to falling?
- tiredness
- dizziness
what are the eight extrinsic risk factors?
- environmental hazards
- inappropriate walking aid
- inappropriate footwear
- poor lighting
- clutter
- clothing
- floor covering
- low furniture
when does footwear increase risk of falling?
- too tight
- too loose
- lack of grip
how does clothing contribute to fall risk?
- long clothes could be tripped on
how many older adults have a fear of failing?
- 30% of older adults have a fear of falling
what type of barrier is fear of falling?
- psychological barrier to exercise
when is fear of falling higher?
- higher risk when individual has fallen in the past
what does fear of falling reduce? (2)
- reduced participation in ADLs and meaningful activity
what does fear of falling increase risk of? (2)
- increased risk of sarcopenia and deconditioning
what is dizziness and light - headedness caused by?
- caused by dehydration, ageing circulation, medical conditions such as parkinson’s disease, heart conditions and some medications for high BP
what could dizziness and light- headedness contribute to?
- could contribute to fluctuating BP and heart conditions
what is postural hypertension ? what can it cause?
- drop in blood pressure when getting up from lying or sitting suddenly
- can cause dizziness and light- headedness
what two other problems can cause dizziness and light- headedness? - give examples
- inner ear problems e.g., acute neuritis, benign paroxysmal positional vertigo (BBPV)
- problems with heart rate/ rhythm e.g., atrial fibrillation= irregular and often very rapid heart rate
what is loss of consciousness caused?
- caused by problems with heart rate and rhythm
what conditions cause loss of consciousness and why?
- bradycardia (slow HR)
- tachycardia (rapid HR)
- atrial fibrillation (irregular HR)
- all conditions reduce blood flow to the brain
what other problem increases risk of falling? - give examples and what do they cause?
- foot problems
e.g., corns, calluses, bunions, ingrown or thick nails and ulcerations - causes pain and discomfort
what do foot problems make it hard to do?
- hard to exercise and keep active
what does numbness in the foot lead to? what is it linked to?
- unable to fully sense where your foot is on the floor
- loss of balance
- may be due to diabetes
what are the four steps of a personalised care plan?
- prepare
- discuss
- document
- review
how often should you review a care plan? when should you follow up?
- review every 3-4 weeks
- follow up for at least 6 months
what should goals be? what does this stand for?
- SMART
- specific, measurable, achievable, relevant, timely
what is a fall a sign of?
- warning sign of a new or worsening health condition
what new and often temporary health conditions can cause falls? (4)
- constipation
- infection (bladder, urinary tract or chest infection)
- dehydration
- sudden confusion (delirium)
what are the 4 main evidence based falls interventions?
- medication management & review
- vision assessment
- environmental assessment
- strength and balance exercise
what are the four medication risk factors?
- polypharmacy
- psychotropic drugs
- hypotensive drugs
- medication compliance
what is polypharmacy?
- 4 or more prescribed medications
what are psychotropic drugs? what can they cause?
- sleeping tablets
- sedatives
- antidepressants
- anti- psychotics
- can cause drowsiness and confusion
what do hypotensive drugs and diuretics cause?
- cause blood pressure to lower
- may cause dizziness
what is medication compliance?
- regularity of medications
when should medication be reviewed? what side effects should you look for?
- reviewed annually
- look out for dizziness, drowsiness and confusion
what would you look for in an environmental risk factor assessment? (5)
- hazards/clutters
- rugs, loose wires, raised thresholds
- poor lighting
- wet flooring
- low temperature
how could you take action regarding the lighting of a patient’s home? why is this important?
- use of natural light (open curtains)
- night light
- important so patient can see when they go to the toilet
what should you avoid regarding flooring aspect?
- avoid swirling patterns and changes in textures
what should be set out in the patients home? what does this avoid?
- everyday items should be set out
- prevents overreaching (organised)
what are the three things you should ensure in the house risk assessment?
- ensure area is hazard/ clutter free
- ensure bedclothes/ nightwear aren’t trailing
- ensure they can safely get on/ off bed/ chair and toilet (check all transfers)
what did the NICE guidelines encourage with regards to falls? what does this translate into?
- a dose of at least 50 hours of exercise is required to reduce falls
- translates a recommendation of two hours of strength & balance training per week over 6 month period
how much can a tailored exercise programme reduce falls up to ?
- reduced falls up to 54%
why would you encourage tai chi?
- because it involves smooth coordinated movement so it trains balance
what are some examples of the time to move lower limb exercises? (5)
- 5 x sit to stand
- 5 x squats
- 5 x hip abduction
- 5 x heel raises
- 5 x calf raises
what other test should be done annually to reduce falls? why?
- eye tests
- to see if person has sensory impairment/ issues with vision
what are patients recommended? what may they be referred to after an eye test?
- recommended ophthalmology
- may be referred to visual impairment officer
what are the 3 key questions that the World Falls Guidance highlights to assist opportunistic case findings?
- Have you experienced one or more falls in the past 12 months?
- Do you feel unsteady when walking or standing?
- Do you have worries about falling?
what happens if the patient answers yes to any of the three key questions set by the World Falls Guidance?
- a risk assessment should be completed or a multifactorial checklist completed
what should you observe once you have identified those that have fallen? what could be offered to aid this?
- observe mobility and gait
- mobility aids provision if competent
what do top tip leaflets include?
- include information such as:
focus on exercises, eye tests, have they had a check up, etc
what is multimorbidity?
- co existence of two or more long- term conditions
what is four or more long term conditions sometimes defined as?
- defined as complex multimorbidity
how is multimorbidity characterised by? (3)
- simple count
- disease score
- clinical grouping
what does multimorbidity cause? what does it overlap with?
- causes polypharmacy
- overlaps with general frailty
how do you manage multimorbidity by minimising?
- minimise disease- specific treatment plans and consider the whole individual
- including interactions between conditions e.g., be aware of polypharmacy
what should you do with the patient when managing multimorbidity’s?
- you should engage with clients to negotiate priorities and set meaningful SMART goals
what should be provided in the management of multimorbidity? - give some examples
- provide clear communication between healthcare settings to streamline the continuum
e.g., write GP letters, give comprehensive handovers
what may be considered to contribute to goal adherence in the management of multimorbidity? - what are some examples?
- motivational and environmental factors considered
e.g., access to transport, social support, mental health resources, voluntary services, charities, leisure centres
what isn’t the problem? what do we need to understand?
- ageing isn’t the problem
- need to understand cognitive, physical and emotional factors
what is the timed up and go test?
- patient starts sat back in a standard arm chair and a line 3 metres or 10 feet away is marked on the floor
what is the patient instructed to do in the timed up and go? when do you begin and stop timing?
- patient instructed to stand up when you say go and walk to the line on the floor, turn then walk back to the chair at normal pace & sit down
- begin timing on go and stop once the patient sits back down
what is the timed up and go result of an individual at risk for falling?
- individual who takes over 12 seconds
what is the 180 degree turn test?
- involves the use of two sturdy supports in which the patient has enough room to stand
- patient faces one of the supports then turns to the other in as little steps as possible
what should be provided if particularly unstable in 180 degree test? what should you record?
- third support required
- record lowest number of steps for half a turn only
what do individuals with an increased risk of falling score in the 180 degree turn test?
- take more than 4 steps to complete a 180 turn
what is the multifactorial falls assessment?
- identifies the modifiable risk factors that predisposes someone to fall and is used to direct the individual to the appropriate assessment and treatment
what age is it essential to have a multifactorial assessment?
- all people aged 65 or older who are admitted to hospital must be assessed
- aged 50-64 are judged by a clinician
what is the backwards chaining method? what can you do once its learnt?
- sequence of movements combined together to help teach someone to be able to get down to the floor safely
- once taught, it can be used in reverse to get off of the floor
what does the backward chaining method require?
- therapist
- sturdy chair
- area with plenty of space
- supportive footwear
what are the first 4 steps of the backwards chaining method?
- face your chair a few steps away
- lunge forward with your strongest leg and hold the sides of the chair seats/ arms
- bend back knee down to floor and bend front knee
- bring other knee to floor
what are the last 4 steps of the backwards chaining method?
- bring one hand off the chair and onto the floor
- bring your other arm down to the floor so you are in four point kneeling
- lower hips/ bottom onto the floor gently so you are sat on the floor
- lower yourself down till you are lying on the floor
