Falls and osteoporosis |X Flashcards
What is the WHO definition of a fall?
What are 2 other definitions?
“An event which results in a person coming to rest inadvertently on the ground or floor or other lower level”
Unintentionally coming to rest on the ground, floor or other lower level; excluding coming to rest against furniture, wall, or other structure
A sudden, unintentional change in position causing an individual to land at a lower level, on an object, the floor, or the ground, other than as a consequence of a sudden onset of paralysis, epileptic seizure, or overwhelming external force
What are some stats of the morbidity and mortality associated with falls (6)?
- Following hip fracture half of those previously independent become partly dependent and one third become totally dependent
- The 1 year mortality in people with fractured neck of femur is 20-35%
- 1% of falls results in a hip fracture
- After a fall an older person has a 50% probability of having serious mobility problems and 10% probability of dying within a year
- Up to age 64 twice as many men as women die in falls and over 74 twice as many women die as men
What % of people aged 80+ fall at least once a year?
50%
What % of people aged 65+ fall each year?
1/3
What are the economic cost of falls in 2000 and what were they spent on?
£1.8 billion on:
- 45% on acute care
- 5% on drugs
- 50% on social care
What are 4 important things to remember when assessing patients that have fallen?
- A fall is not a diagnosis; it is a presenting complaint
- It is essential to diagnose the cause of the fall
- All falls are mechanical i.e. some form of mechanism is involved
- Most health professionals who talk about “mechanical falls” are actually referring to an environmental cause for the fall
What adverse outcomes are falls associated with?
- Fear of falling which ultimately limits the performance of daily activities, leading to activity limitation, participation restriction, low quality of life, anxiety and depression
- Social isolation due to fear of falling
- Depression and anxiety due to fear of falling, social isolation and difficulties with activities of daily living
- Injuries and fractures
- Death
- Carer strain worrying about the risk of falling
- Institutionalisation
What are intrinsic and extrinsic causes of falls?
Intrinsic: are basically related to how well the person can see, how well they can walk or maintain their balance, what kind of muscle strength they exhibit, and how well they can endure physical activity.
-Diseases that affect the cardiovascular, neurological, or musculoskeletal systems can increase an older person’s risk of falling.
Extrinsic factors: are related to the person’s physical environment, including their home, such as poor lighting, slippery floors, or throw rugs.
-This category also includes assistive devices such as use of a cane, frame, or wheelchair and inappropriate clothing or footwear.
What are other specific risk factors for falls (9)?
- Cognitive impairment
- Continence problems
- Falls history, including causes and consequences (such as injury and fear of falling)
- Footwear that is unsuitable or missing
- Health problems that may increase their risk of falling e.g. stroke/diabetes/hypoglycaemia
- Medication
- Postural instability, mobility problems and/or balance problems
- Syncope syndrome
- Visual impairment
What 5 important systems may be affected, leading to falls?
What diseases affect them?
- Vision - required for spatial orientation
- Cataracts
- Age-related macular degeneration
- Diabetic retinopathy
- Bifocal lenses - Proprioception - helps with orientation when the eyes are shut or vision is impaired
- Sensory neuropathy
- Joint replacements
- Ageing - Vestibular system- orientation in three dimensions, by use of the three semi-circular canals at 90 degrees to each other. This system responds rapidly to head movements
- Previous middle ear infections
- Menière’s disease
- Ototoxic drugs - Brain - helps to integrate and coordinate the sensory inputs mentioned above, and tells the body what to do in order to counteract any challenge to the upright posture. It is also involved in judgment and risk taking
- Cerebrovascular disease
- Dementia (affects judgment)
- Low blood pressure (reduces cerebral blood flow) - Effector mechanisms - in particular the quadriceps muscles, are the main mechanisms which the body uses to re-balance
- Proximal myopathy (e.g. steroid exposure, vitamin D deficiency)
- Any neurological disease
- Disuse atrophy
Having identified someone who has fallen, what are the 3 steps you need to take to minimise the risk of falling again?
- Strength and balance training
- Environmental assessment
- Medical review
This three pronged method aims to address the intrinsic risk factors (such as reduced balance, or visual deficits), as well as extrinsic deficits, such as unnecessary medication and home environmental hazards.
What does strength and balance training involve?
A physiotherapist making an assessment of an individual and then prescribing a tailored course of therapy aimed at improving strength and balance.
The therapy might involve a variety of activities, such as cardiovascular training (e.g. on an exercise bike), strength training (resistance training using weights or Therabands©) and balance training (for example, using a wobble board). This usually lasts many weeks – some people have suggested at least 50 hours is required
What does the environmental assessment involve?
The environmental assessment should always be led by an occupational therapist.
The OT will assess the individual and the environment to identify any potential hazards, by visiting the individual at their home.
The OT will suggest improvements to be made if necessary and may provide some assistive equipment.
e.g. bath, toilet, devices to help dressing, grab rails, camouflage carpets that can hide objects or difficulty viewing steps in poor lighting
What does the medical review involve?
- Diagnose medical reasons for falls including:
- Cardiovascular causes e.g. syncope/postural hypotension
- Neurological causes e.g. stroke
- Psychiatric causes e.g. dementia
- Infective causes e.g. UTI causing a delirium
- Opthalmic causes e.g. cataracts - Optimise the Management of Conditions Contributing to Falls. Older patients have multiple co-morbidities, many of which can contribute to an increased risk of falling, so need to optimise management
- Opthalmic e.g. cataract surgery, correct vision
- Endocrine e.g. optimise diabetic control (diabetic retinopathy and neuropathy; avoid hypos)
- Urological e.g. manage overactive bladder - Bone health - Look for evidence of a previous major fracture (hip, vertebral) and prescribe bone protection in appropriate individuals.
In those without history of major fracture consider assessing bone density using bone densitometry (DEXA) - Medication review
- All older patients should have a regular review of their medications.
- Polypharmacy increases the risk of falls.
What are 2 investigations all people need to have following a fall?
ECG
Postural BP checked
