Falls and syncope

Question 1

adverse outcomes associated with falling in older people?

Answer 1

fear of falling-assoc. with limitation of activity, participation restriction (withdraw from society), low QOL, anxiety and depression.
social isolation
fractures and injury
death
carer strain
institutionalisation
depression and anxiety

Question 2

how can RFs for falls be categorised?

Answer 2

intrinsic and extrinsic factors

Question 3

examples of extrinsic factors putting pt at risk of falls?

Answer 3

rugs
highly polished floors
drawing the curtains that are difficult to reach
poorly fitting slippers
walking stick
drugs-BZDs, antidepressants, antipsychotics

Question 4

medications particularly responsible for increasing falls risk in elderly patients?

Answer 4

antihypertensives
BZDs-drowsy, reduce alertness to environment, blunt reaction to falling
hypoglycaemic drugs e.g. sulfonylureas, can drop blood sugar to level that causes weakness and reduced awareness
alcohol-problems with judgement, BP+HR, cerebellar function

Question 5

why does orthostatic hypotension occur in older people?

Answer 5

impaired baroreceptor response and decreased adrenergic sensitivity so failure to increase the HR on standing, and effects exacerbated by medications which reduce the HR (beta blockers, Ca2+ channel blockers), and cause chronic vasc contraction (diuretics, dehydration).

Question 6

how does situational syncope (type of reflex syncope) e.g. micturition or cough, happen?

Answer 6

syncope induced by a valsalva maneuver which impairs preload by increasing intrathorac pressure, and causes vagal bradycardia.

Question 7

most important qn in a falls history?

Answer 7

number of falls the patient has had in the last 12 months?
how at risk is this pt of future falls and therefore how important is it to address any possible intrinsic or extrinsic factors contributing to their falls risk.

Question 8

what questions should be asked to determine function of an elderly pt pre-injury?

Answer 8

must looks at ADLs and IADLs-instrumental activities of daily living
ADLs: transferring, toileting, bathing, dressing, feeding, continence.
IADLs: meal preparation, housekeeping, medication management, finances, transportation/driving, shopping phone and use of technology.

Question 9

define a fall

Answer 9

inadvertently coming to rest on the ground or other lower level with/without LOC and other than as a consequence of overwhelming external force, epileptic seziure, sudden onset paralysis or excess alcohol intake.