Falls and UI Flashcards
Falls
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
Significance of Falls
Individual
- affects ADLs
- end of walking independently
Broader Scale:
- quality indicator (depression, pain, PU, falls)
- punitive in some cases
Falls cause
top reason for hospitalizations and ED visit
a. hip fractures
b. wrist fractures
c. traumatic brain injuries
d. spinal cord injuries
leads to frailty
Types of Falls
- Slip and trips
- Falls on stairs
- Falls from furniture
turning, incorrect weight shifting, transferring, forward walking
Risk Factors for Falls
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
Modifiable Risk Factors
Intrinsic Factors:
- muscle weakness
- vision problems
- gait and balance problems
Extrinsic Factors:
- psychoactive meds
- environment
Medications and Falls
- decreased mental alertness
- impaired cognitive function and/or judgment
- impaired postural stability
- hypotension
- postural hypotension
- arrhythmias
Risk Factors for Significant Injury due to Falls
- Current use of anticoagulants
- Patients with osteoporosis
- Post surgical patients
- History of Falls
Osteoporosis
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
Prevention of Falls
Clinical Practice Guidelines
- Screen for falls or risk for falling
- Evaluation of gait and balance
- Determination of multifactorial fall risk
- reveal the factors that put an older adult at risk; can help identify interventions - Initiate multifactorial or multicomponent interventions
Interventions to reduce fall risk
- minimize medications
- provide individually tailored exercise program
- treat vision impairment
- mange postural hypotension
- manage heart rate and rhythm abnormalities
- supplement vitamin D
- manage foot and foot ware problems
- modify home environment
- provide education and information
Environmental Risks
Clinical setting:
- cluttered path
- spills
- brake not on
- bed at high height
- cords
Home setting:
- rugs
- poor lighting
- unsteady furniture
- walker out of reach
Technological and other interventions
- video capture
- wearable sensors
- lifeline (stigma)
- hip protectors (padded)
- compliant/cushioned flooring
Urinary Incontinence
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
Myths of UI
- 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
Requirements of Continence
- Intact lower urinary tract function
- Intact brain and spinal cord
- Cognitive ability to recognize urge to void
- Functional ability to get to the toilet or commode in a timely manner (and ability to suppress urge until then)
- Motivation to maintain continence
Age related changes in the lower urinary tract
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)
Types of Urinary Incontinence
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
Causes of UI
Temporary UI
- certain food, drinks or medications
Persistent UI
- age, enlarged prostate, prostate cancer, obstruction (stones), neurological disorders
Impact of UI
- physical
- psychosocial
- economical
- depression
- poor self-rated health
- poor health related quality of life
Urge UI is associated with
a. falls and fractures
b. skin irritation and infections
c. UTI
d. PU
e. limitations of functional status
Assessment of Transient UI
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
Interventions for UI
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
Post-void residual measurement
Measuring urine in bladder after voiding
- may indicate an obstruction in urinary tract or problem with bladder nerves or muscles
