Falls - Block 4 Flashcards
Describe the progressions to falls?
Fraility -> falls -> debility
Wha are the potential complications for falls?
- SOft tissue injury
- Fractures
- Subdural hematoma
- Hospitalization
- Limited mobility
What are intrinsic RF for falls?
- Medical and neurological conditions, sensory impairment
- Age related changes in NM function, reflexes, and gait
What is the difference between older men and women walks?
Men: wide-based, short stepped gaits
Women: narrow-based, waddling gait
What are extrinsic RF for falling?
- Medications
- Improper footwear or use of assistive devices
- Environmental hazards
What are meds that contribute to fall risk?
- Antihypertensives/ alpha-blockers -> bradycardia/hypotension
- Antidepressants -> postural hypotension
- Cholinesterase inhibitors -> bradycardia
- Diuretics -> hypovolemia
- Sedatives -> sedation
- Antipsychotics -> sedation, muscle rigidity, postural hypotension
- Hypoglycemics -> acute hypoglycemia
- Alcohol -> acute intoxication
What are examples of improper footwear?
Older adults have lower arches and increased circumference of foot unit
Narrow or small shoes: Pain
Loose shoes: lower gait speed, shorter stride length, irregular gait pattern
What are the goals for assistive devices?
Improve independent mobility, reduce disability, delay functional decline, and decrease the burden of care
What are the types of assistive devices?
- Canes (standard, offset, quadripod)
- Crutches (axillary, forearm, platform)
- Walkers (standard, front-wheeled, four-wheeled)
What are the difficulties of using assistive devices?
- Lifting and advancing the device -> destabilization
- Need to allocate attention to control device -> disrupts balance
- Interference with limb movements
- Repetitive stress on upper extremity joints -> tendinopathy, OA, carpal tunnenl
How do we determine what walking device we use?
What are the environmental hazards of using assistive devices?
- Slippery surfaces
- Inadequate lighting
- Loose, deep pile, or worn carpets
- Staircases without railings
- Unsupportive or badly arranged furniture
- Poorly designed tubs, toilets, and fixtures in the bathroom
- Clutter
- Pets underfoot
WHat are the behavioral RF?
- Performing behaviors that could increase fall risk
- Not performing behaviors that could reduce fall risk
- Selecting unsafe clothing, footwear, or inappropriate or outdated eyewear prescriptions
What are the core elements for fall prevention?
- Screen
- Assess
- Intervene
How do we help others prevent falls?
- Adaptation or modification of home environment
- Withdrawal or minimization of psychoactive medications
- Withdrawal or minimization of other medications
- Management of postural hypotension, urinary frequency/urgency, vitamin D deficiency
- Management of foot problems/footwear, visual impairment
- Exercise, particularly balance, strength, and gait training
- Increase caution or awareness and reduce other high-risk behaviors