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

Falls and their consequences Flashcards by Aditi Mukherjee

What is a fall?

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

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

goes outside of the base

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What is syncope?

loss of consciousness

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How much do falls cost the NHS a year?

£2.3 billion a year

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

1 in 3

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

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

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Why do we fall?

Age related changes
co-mordbidities and polypharmacy
Environment

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What are age related reasons as to why we fall?

NEUROLOGICAL:
ageing muscle
posture change
vision change
hearing change
gait change

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

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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What happens to ageing muscle?

sarcopenia= loss of skeletal muscle and strength

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What is normal posture?

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

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What happens to posture as we get older?

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

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What is the posture in ageing people known as?

hyper-extended hyper-lordotic posture

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How does ageing gait change?

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

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What are the 2 functions of the ear?

hearing

maintaining balance

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How is hearing affected as we age?

loss of outer and inner hair cells

so high frequency sounds are hard to hear

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How does the ageing ear affect balance?

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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How does the eye change with old age?

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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What pathologies occur in the eye?

cataracts
age related macular degeneration
glaucoma
diabetic and hypertension related retinopathy
stroke

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How can stroke increase risk of fall?

with stroke, you have hemiplegic gait which makes you unsteady

How does parkinson’s increase the risk of falling?

Parkinson’s patients adopt a shuffling gait

How does arthritis increase risk of falling?

you get an antalgic gait (painful)

How does a neuropathy increase risk of falling?

can develop footdrop- drooping over curb

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

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

What kind of comorbidities of the CVS can cause falls?

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

Give examples of benzodiazepines:

diazepam, temazepam | these are not very often prescribed in older adults

Give a hypnotic drug:

zopiclone (sleeping pill for insomnia)

What are amitriptyline, mirtazepine?

sedating antidepressants

What is piriton?

sedating antihistamine

What are primary consequences of falls?

mortality morbidity fracture- rib, hip head injury

What are the secondary consequences of falls?

``` 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 ```

What kind of assessment is needed when someone falls?

multifactorial assessment

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

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

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

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

When someone has fallen, what should be worked on?

Cochrane study: strength, balance, flexibility, endurance

What is a fragility fracture?

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

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

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

What can happen as a result of a hip fracture?

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

When do you not do an operation?

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

What is an intracapsular fracture?

neck of femur fracture

How do you treat an intracapsular fracture?

metal prosthetics | hemiarthroplasty or a total hip replacement-

What is hemiarthroplasty?

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

What is an extracapsular fracture?

trochanteric fracture or sub-trochanteric

What is a trochanteric fracture?

between greater and lesser trochanters

How do you treat a trochanteric fracture?

with a dynamic hip screw

What is a sub-trochanteric fracture?

5cm below lesser trochanter

How do you treat a sub-trochanteric fracture?

intramedullary screws

How do you prevent falls?

Identify those at risk of falling Assess risk (including fracture risk) Reduce risk Maintain risk reduction

What are some falls prevention programmes?

Multicomponent Exercise programmes Tai Chi