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
What is a fragility fracture?
Fracture that results from a fall at standing height or less
Describe the fragility fracture career, including the 3 main types of fractures and how they progress
- Colles’ - fall onto outstretched hands
- Vertebral - spontanepus, vertebra collapses under body weight - sign of osteoporosis
- Hip - most severe
What is a hip fracture?
Break in the upper quarter or proximal part of the femur
What is the mortality and prognosis of hip fractures?
- 10% die within 1 month
- 1 in 3 die within 1 year
- 50% left with permanent disability
- 10-20% of prev independent patients require residential or nursing home placement
What are the types of hip fracture?
- Intracapsular - neck of femur
- Extracapsular - trochanteric or subtrochanteric
What can be done for an intracapsular hip fracture?
- Hemiarthroplasty
- Total hip replacement (longest, complex)
- Cannulated screws (fastest, no displacement)
What is the surgical treatment for an extracapsular trochanteric hip fracture?
Dynamic hip screw
What is the surgical treatment for an extracapsular subtrochanteric hip fracture?
Intramedullary nail
Who is part of the full multidisciplinary team looking after patients with these hip fractures?
- Orthopeaedic team
- Anaesthetic team
- Orthogeriatric team
- Hip fracture specialist nurse
- Trauma coordinator
- Nursing team
- Therapists (physio, OT, SALT)
- Dietician
- Discharge coordinator + social services
- Community rehabilitation team
What do post-operative management include?
- By orthogeriatric team
- Identify cause of fall
- Reduce risk of further falls
- Bone health
- Manage complications
- Discharge planning incl rehabilitation
Rapid mobilisation of patients is key following surgery. What complications can develop post-operatively?
- Infection -> pneumonia, wound or deep-seated infection
- Reduced mobility -> pressure sores
- Prosthesis failure
- Delirium
- Heart disease
- Thromboembolism
