Falls and UI Flashcards

1
Q

Falls

A

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

A challenge to your balance which is greater than your ability to stand up right

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2
Q

Significance of Falls

A

Individual

  • affects ADLs
  • end of walking independently

Broader Scale:

  • quality indicator (depression, pain, PU, falls)
  • punitive in some cases
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3
Q

Falls cause

A

top reason for hospitalizations and ED visit

a. hip fractures
b. wrist fractures
c. traumatic brain injuries
d. spinal cord injuries

leads to frailty

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4
Q

Types of Falls

A
  1. Slip and trips
  2. Falls on stairs
  3. Falls from furniture

turning, incorrect weight shifting, transferring, forward walking

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5
Q

Risk Factors for Falls

A

Intrinsic Factors

a. advanced age
b. history of falls
c. muscle weakness
d. poor vision
e. postural hypotension
f. fear of falling

Extrinsic Factors

a. poor environmental design
b. dim lighting
c. slippery/uneven surfaces
d. improper use of assistive device
e. psychoactive medications
f. obstacles and tripping hazards

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6
Q

Modifiable Risk Factors

A

Intrinsic Factors:

  • muscle weakness
  • vision problems
  • gait and balance problems

Extrinsic Factors:

  • psychoactive meds
  • environment
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7
Q

Medications and Falls

A
  • decreased mental alertness
  • impaired cognitive function and/or judgment
  • impaired postural stability
  • hypotension
  • postural hypotension
  • arrhythmias
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8
Q

Risk Factors for Significant Injury due to Falls

A
  1. Current use of anticoagulants
  2. Patients with osteoporosis
  3. Post surgical patients
  4. History of Falls
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9
Q

Osteoporosis

A

Bone disease that occurs when body loses too much bone, makes too little bone or both; bones become weak and may break

Loss of bone density

Risk Factors:

  • older women
  • advanced age
  • race (white/asian)
  • family hx
  • small body frames
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10
Q

Prevention of Falls

Clinical Practice Guidelines

A
  1. Screen for falls or risk for falling
  2. Evaluation of gait and balance
  3. Determination of multifactorial fall risk
    - reveal the factors that put an older adult at risk; can help identify interventions
  4. Initiate multifactorial or multicomponent interventions
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11
Q

Interventions to reduce fall risk

A
  1. minimize medications
  2. provide individually tailored exercise program
  3. treat vision impairment
  4. mange postural hypotension
  5. manage heart rate and rhythm abnormalities
  6. supplement vitamin D
  7. manage foot and foot ware problems
  8. modify home environment
  9. provide education and information
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12
Q

Environmental Risks

A

Clinical setting:

  • cluttered path
  • spills
  • brake not on
  • bed at high height
  • cords

Home setting:

  • rugs
  • poor lighting
  • unsteady furniture
  • walker out of reach
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13
Q

Technological and other interventions

A
  • video capture
  • wearable sensors
  • lifeline (stigma)
  • hip protectors (padded)
  • compliant/cushioned flooring
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14
Q

Urinary Incontinence

A

A condition in which involuntary loss of urine is a medical, social and hygiene problem and is objectively demonstrable

1 in 5 persons over 65yo

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15
Q

Myths of UI

A
  • a normal part of aging
  • to be expected after childbirth
  • not treatable except by surgery
  • should be accepted and managed using pads and/or pills

Half of those who suffer from UI don’t consult HCP

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16
Q

Requirements of Continence

A
  1. Intact lower urinary tract function
  2. Intact brain and spinal cord
  3. Cognitive ability to recognize urge to void
  4. Functional ability to get to the toilet or commode in a timely manner (and ability to suppress urge until then)
  5. Motivation to maintain continence
17
Q

Age related changes in the lower urinary tract

A

Decreased:

  • bladder capacity
  • sensation of filling
  • speed of contraction of detrusor
  • pelvic floor muscle bulk
  • sphincteric resistance
  • urinary flow rate

Increased:

  • urinary frequency
  • prevalence of post-void residual volumes
  • outflow tract obstruction (men)
18
Q

Types of Urinary Incontinence

A

a. Stress incontinence
- coughing, sneezing, laughing

b. Urge incontinence
- sudden, intense urge
- infection, neurologic disorder

c. Overflow incontinence
- frequent or constant dribbling, bladder doesn’t empty completely

d. Functional incontinence
- physical or mental impairment

e. Mixed incontinence

19
Q

Causes of UI

A

Temporary UI
- certain food, drinks or medications

Persistent UI
- age, enlarged prostate, prostate cancer, obstruction (stones), neurological disorders

20
Q

Impact of UI

A
  • physical
  • psychosocial
  • economical
  • depression
  • poor self-rated health
  • poor health related quality of life
21
Q

Urge UI is associated with

A

a. falls and fractures
b. skin irritation and infections
c. UTI
d. PU
e. limitations of functional status

22
Q

Assessment of Transient UI

A

a. incontinence hx
- onset, bladder diary, duration

b. fluid intake
- caffeine, alcohol

c. bowels
- constipation, laxatives, patterns

d. medical hx
- diabetes, stroke, UTIs

e. medication hx
- diuretics, antidepressants

f. functional abilities
- access to bathroom, ambulation needs

g. physical assessment
- skin integrity, bladder distension

h. other
- post-void residuals, cystoscopy

23
Q

Interventions for UI

A

a. Scheduled/prompted voiding
- based on bladder diary patterns
- q2-4hrs

b. Lifestyle changes
- do not ignore urge to void
- drink 1.5-2L of fluid per day, before 8pm
- reduce caffeine and alcohol
- education about age-related changes

c. In-hospital
- ensure toileting and mobility devices within reach
- provide assistance
- start with bedpan before briefs
- clear path to toilet

24
Q

Post-void residual measurement

A

Measuring urine in bladder after voiding

- may indicate an obstruction in urinary tract or problem with bladder nerves or muscles

25
Q

Containment Products

A

a. incontinence briefs/protective undergarment
b. condom catheters
c. intermittent catheterization (urinary retention)
d. barrier cream (skin integrity)