Falls and their Consequences Flashcards
What is a fall?
- Unintentional, unexpected loss of balance
- Coming to rest on the ground or floor or on object below knee level
- A person’s centre of mass goes outside of their base support
What proportion of people >65yrs living at home will fall at least once a year? What about >80 years?
- 1 in 3 >65
- 1 in 2 of these will fall more often than that
- 1 in 2 >80 years at home or in residential care will fall at least once a year
Falls are the most common cause of injury related death in people >75 yrs. What is the cost of this?
Cost of £2.3 billion per year to NHS
Why are elderly women more likely to fall than men?
- Women falls 50-60% higher than men
- Men have more muscle strength than women
- Men have wider posture (anatomical/cultural)
- Pedometers -> women move around a lot more
Why do patients fall?
Intrinsic + extrinsic factors, ACE:
- Age related changes
- Co-morbidities (incl medications)
- Environment
What processes of the ageing neurological system contribute to patients suffering falls?
- Loss of neurons
- Demyelinated neurons -> slower processing speed + inc latency
- Sensory impairment (fine touch/vib/proprio)
- Impairment of vestibular system
What is sarcopenia and how does it contribute to ageing?
- Loss of skeletal muscle mass + strength
- Not uniform so more loss from legs than arms for example
Describe changes in a patient’s gait that might contribute to falls
- Reduced stride length
- Reduced gait speed
- Reduced hip flexion + extension
- Wide based gait
What occurs in the ageing eye?
- Steady deterioriation in static acuity
- More pronounced loss of dynamic visual acuity
- Slower reaction to changes in lighting
- Reduced sensitivity of colour contrast
- Reduced depth perception
- Long sightedness
Name some co-morbidities of balance/gait that could make a patient fall
- Stroke
- Parkinsonism
- Arthritis
- Neuropathy
- Vestibular disease
- Neuromuscular disorders
Name some co-morbidities of visual impairment that could make a patient fall
- Cataracts
- Glaucoma
- Macular degeneration
- Retinopathy
Name some co-morbidities of cognition that could make a patient fall
- Dementia
- Delirium
Name some co-morbidities of cardiovascular origin that could make a patient fall
- Orthostatic/postural hypotension
- Post prandial hypotension
- Carotid sinus syncope
- Neurocardiogenic syncope
- Arrhythmias
- Valvular heart disease
How does incontinence lead to falls?
- Slipping, if the floor is wet
- Mainly about people trying to rush to the toilet to avoid being incontinent
What condition makes you generally weak and likely to fall?
Anaemia
Which medications increase risk for falls?
- Benzodiazepines
- Hypnotics
- Antidepressents
- Opiates
- Anti-epileptics
- Alpha-blockers
- Diuretics
- Beta blockers
- ACE inhibitors
- Sedating antihistamines
Which extrinsic factors can impact on the risk of falls?
- Lighting
- Rails
- Headroom + clearance
- Rugs + carpets
- Clothing + footwear
- Mobility aids
The main consequence of falling is injury, including fractures and head injury. What are secondary consequences of falls?
- Chest infection
- Pressure sore
- Dehydration
- Muscle atrophy
- Pain
- Burns
- Hypothermia
What are psychological consequences of falls?
- Fear of falling
- Reduced confidence
- Loss of independence
- Low mood -> depression (?)
Doctors are routinely meant to ask older people about falls. When should a full multifactorial risk assessment be carried out on a patient?
Have one of the following:
- > 1 fall per year + living in community
- 2+ falls per year
- abnormality of gait/balance
What areas needs to be assessed in a Multifactorial Risk Assessment for falls?
- Cognitive impairment
- Syncope
- Sensory impairment
- Footwear
- Health problems increase risk of falling
- Medication
- Balance + mobility problems
- Home hazards
- Falls history
- Continence problems
What do physiotherapists focus on when dealing with falls patients?
- Exercise
- Strength + balance
- Core stability
- Confidence
- Rehabilitation
- Mobility aids
Occupational therapists work hand-in-hand with physiotherapists. What do they do for falls patients?
- Functional assessment
- Home visit (assess for home hazards)
- Modified furniture
- Pendant alarms
- Aids
What consists of the falls prevention programme?
- Multicomponent
- Exercise programmes
- Tai Chi
