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
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 are the types of hip fracture?
- Intracapsular - neck of femur
- Extracapsular - trochanteric or subtrochanteric
