Falls and their Consequences

Question 1

What Postural changes occur with age?

What Gait changes occur with age?

Answer 1

• Lumbar Lordosis, Thoracic Kyphosis and Cervical Lordosis exaggerated
• Reduced stride length and gait speed, Wide-based gait, Reduced hip flexion & extension

Question 2

What are the risk factors for a fall?

Answer 2

• • Balance impairment, Bradykinesia and Coordination issues
  • Sarcopenia, Osteoporosis, Frailty
  • Vision and Hearing impairment
  • Co-morbidities e.g. Parkinson’s, Vestibular disease, Retinopathy, Dementia, Postural hypotension, Anaemia
  • Specific medications e.g. Benzodiazepines, Hypnotics, ACEi, B-blockers, Diuretics
  • Lighting, Carpets, Handrail, Clothing, Footwear, Mobility aids

Question 3

What are the Physical consequences of a fall?

What are the Psychological consequences of a fall?

What are the Secondary complications after a fall?

Answer 3

• Fractures (Hip), Head injury (IC Haemorrhage)
• Reduced confidence, Loss of independence, Low mood/depression
• Chest infections, Pressure sores, Dehydration, Muscle atrophy, Burns, Hypothermia

Question 4

FALL PREVENTION:
What assessment is done in the elderly after a fall?
→ What does it include?
→ What is very important to ask about?

What else can be done?

Answer 4

• MULTIFACTORIAL FALL RISK assessment
  → Cognitive impairment, Footwear, Falls history (Causes & consequences), Continence problems, Health problems that increase the risk of falling, Medication, Sensory impairment, Syncope
  → Falls history (Causes & consequences)
• Assess hazards in home, Alarm systems, Rehabilitation (exercise, strength, balance)

Question 5

HIP FRACTURE:
What does it present with?

What are the 3 types?

What is a Fragility fracture?

Management:
Why types of surgery can be done?

What complications can occur after the surgery?

Answer 5

• Shortened and Externally rotated leg, Pain and Inability to weight bear (stand)
• • Neck of femur (Intracapsular)
  • Trochanteric, Sub-trochanteric (Extracapsular)
• Fractures as a result of normal activities (fall from standing height)

• Hemiarthroplasty, Total Hip Replacement, Cannulated Screw, Dynamic Hip Screw (DHS), Intramedullary Nail

- • Pneumonia
• Reduced mobility and Pressure sores
• Prosthesis failure
• Delirium
• Heart disease and Thromboembolism