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WEEK 7 SEM 4 > Falls and their consequences > Flashcards

Falls and their consequences Flashcards

1
Q

What is a fall?

A

an event which results in a person coming to rest inadvertently on the ground or floor or other lower level

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2
Q

What happens to a person’s centre of mass when they fall?

A

goes outside of the base

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3
Q

What is syncope?

A

loss of consciousness

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4
Q

How much do falls cost the NHS a year?

A

£2.3 billion a year

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5
Q

How many people over 65 will fall at home at least once a year?

A

1 in 3

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6
Q

Why are patients in care homes more likely to fall than if at home?

A

if in care home, more likely to be frailer
new environment
many medications
restricted activity

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7
Q

Why do we fall?

A
  1. Age related changes
  2. co-mordbidities and polypharmacy
  3. Environment
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8
Q

What are age related reasons as to why we fall?

A 
NEUROLOGICAL:
ageing muscle
posture change
vision change
hearing change
gait change
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9
Q

How do neurological changes in ageing people make you more likely to fall?

A

Brain atrophy- slower processing speed
Loss of neurons- loss of proprioceptive sensitivity
Reduced synaptic transmission- impaired vestibular system

ALL LEADS TO BALANCE IMPAIRMENT

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10
Q

What happens to ageing muscle?

A

sarcopenia= loss of skeletal muscle and strength

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11
Q

What is normal posture?

A

thoracic spine- OUTWARD curve
Lumbar spine- INWARD curve
Sacrum- OUTWARD curvature

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12
Q

What happens to posture as we get older?

A 
Lumbar lordosis (exagerate lordosis inward curve)
exaggerated thoracic kyphosis (outward curvature)
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13
Q

What is the posture in ageing people known as?

A

hyper-extended hyper-lordotic posture

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14
Q

How does ageing gait change?

A

slow walking speed
large stride length
less hip flexion and extension
very wide base

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15
Q

What are the 2 functions of the ear?

A

hearing

maintaining balance

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16
Q

How is hearing affected as we age?

A

loss of outer and inner hair cells

so high frequency sounds are hard to hear

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17
Q

How does the ageing ear affect balance?

A

in the inner ear, in the semi-circular canals and the otolith system
the semi circular canals have reduced by 40% by the age of 70-the otolith start to fragment and degenerate

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18
Q

How does the eye change with old age?

A 
pupils less elastic
opaque lens
less sensitivity to colour contrast
slower reaction to change in lighting
long sighted
steady deterioration in steady vision
more deterioration in moving vision
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19
Q

What pathologies occur in the eye?

A 
cataracts
age related macular degeneration
glaucoma
diabetic and hypertension related retinopathy
stroke
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20
Q

How can stroke increase risk of fall?

A

with stroke, you have hemiplegic gait which makes you unsteady

21
Q

How does parkinson’s increase the risk of falling?

A

Parkinson’s patients adopt a shuffling gait

22
Q

How does arthritis increase risk of falling?

A

you get an antalgic gait (painful)

23
Q

How does a neuropathy increase risk of falling?

A

can develop footdrop- drooping over curb

24
Q

What could co-morbidities effect which could increase risk of falls?

A

vision
cognitive functions- dementia/delirium so might forget walking stick/frame
cardiovascular systems

25
Q

What kind of comorbidities of the CVS can cause falls?

A 
orthostatic hypotension (hypotension because of low movement or being stationary)
post prandial hypotension (after a meal)
carotid sinus syncope
neurocardiogenic syncope
arrhythmias
valvular disease
26
Q

Give examples of benzodiazepines:

A

diazepam, temazepam

these are not very often prescribed in older adults

27
Q

Give a hypnotic drug:

A

zopiclone (sleeping pill for insomnia)

28
Q

What are amitriptyline, mirtazepine?

A

sedating antidepressants

29
Q

What is piriton?

A

sedating antihistamine

30
Q

What are primary consequences of falls?

A

mortality
morbidity
fracture- rib, hip
head injury

31
Q

What are the secondary consequences of falls?

A 
patients who have had a rib fracture and cannot inflate their lungs to the full capacity (shallow breaths) can get chest infections
bed bound= chest infection
bed bound= pressure sores
bed bound= muscle atrophy
burns
hypothermia−because they cannot get warm
32
Q

What kind of assessment is needed when someone falls?

A

multifactorial assessment

33
Q

What things do we need to look at if they have fallen?

A

losing consciousness?
footwear?
sensory- visual/hearing?
medications?

34
Q

Who is involved in the care of a patient who has fallen over?

A 
OT= visit home and sort problems
Paramedics= patients wear pendants- if they fall they press it and paramedics come
Physiotherapists= exercise programmes
35
Q

When someone has fallen, what should be worked on?

A

Cochrane study: strength, balance, flexibility, endurance

36
Q

What is a fragility fracture?

A

a fracture that occurs in result of a low impact trauma generally from standing height (falling from standing)

37
Q

When you look at a hip fracture what does it look like?

A

shortened and externally rotated
painful to move
can’t bear weight

38
Q

What can happen as a result of a hip fracture?

A

patient becomes anaemic (lots of blood loss) so need blood resuscitation

39
Q

When do you not do an operation?

A

if person is too unwell for operation

or if person has impacted fracture where fragments of fracture are in line so can have conservative management

40
Q

What is an intracapsular fracture?

A

neck of femur fracture

41
Q

How do you treat an intracapsular fracture?

A

metal prosthetics

hemiarthroplasty or a total hip replacement-

42
Q

What is hemiarthroplasty?

A

hemiarthroplasty only replaces the head of the femur, and leaves the acetabulum intact-the total hip replacement replaces the femoral head, and also the acetabulum

43
Q

What is an extracapsular fracture?

A

trochanteric fracture or sub-trochanteric

44
Q

What is a trochanteric fracture?

A

between greater and lesser trochanters

45
Q

How do you treat a trochanteric fracture?

A

with a dynamic hip screw

46
Q

What is a sub-trochanteric fracture?

A

5cm below lesser trochanter

47
Q

How do you treat a sub-trochanteric fracture?

A

intramedullary screws

48
Q

How do you prevent falls?

A

Identify those at risk of falling

Assess risk (including fracture risk)

Reduce risk

Maintain risk reduction

49
Q

What are some falls prevention programmes?

A

Multicomponent

Exercise programmes

Tai Chi

WEEK 7 SEM 4 (7 decks)

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