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Geriatrics 1 > Falls & Gait Evaluation > Flashcards

Falls & Gait Evaluation Flashcards

1
Q

Ask ALL pt:

A

Have you had any falls in the last year?

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2
Q

Example of a gait assessment tool

A

Get up & go

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3
Q

Most gait disorders ARE or AREN’T associated with underlying disease

A

ARE

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4
Q

Important component of neurological exam

A

Describing pt. gait

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5
Q

How to perform the get up & go test

A

Risk from a chair w/ arms, walk 10 feet, turn, return to chair & sit down

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6
Q

Most adults can complete the get up & go in ____ seconds

A

10-12

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7
Q

A get up & go test of ___ seconds indicates increasing risk for falls

A

> 14

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8
Q

A get up & go test of ___ seconds indicates HIGH risk for falls (more comprehensive eval indicated)

A

> 20

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9
Q

Results of the get up & go are strongly associated with……

A

Functional independence of ADLs

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10
Q

Reduction in gait speed is ass. w/

A

Poorer health status, poorer physical functioning, more disabilities, additional rehab visits, longer hospital stays, high costs
*Increase in speed has the opposite effects!!

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11
Q

How do we measure comfortable gait speed?

A

Timed walk

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12
Q

Conditions that contribute to gait disorder

A
  • DJD
  • Acquired MSK deformities (e.g. RA, gout)
  • Intermittent claudication
  • Impairments following ortho surgery, stroke
  • Postural hypotension
  • Dementia
  • Fear of falling

USUALLY MULTIFACTORIAL (e.g. dementia + antalgic gait s/p failed hip surgery)

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13
Q

________ is not a common cause of falls

A

Syncope (own entity, NOT a multifactorial event -> what we’re worried about)

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14
Q

Antalgic gait

A

Shortened phase of gait on painful side; pain-induced

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15
Q

Circumduction gait

A

Outward swing of leg ass. w/ neurologic disorder

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16
Q

Festination gait

A

Acceleration of gait; PD pt.

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17
Q

Foot drop

A

Loss of ankle dorsiflexion; indication for orthotic evaluation

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18
Q

Trendelenburg gait

A

Weakness in pelvic stabilizing muscles -> affected hip drops w/ step (supposed to lift); r/t myopathy

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19
Q

Fall definition

A

Coming to rest inadvertently on the ground or at a lower level

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20
Q

___ of older adults reported a fall (2014)

A

A quarter

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21
Q

Leading cause of death from injury in persons aged >65

A

Falls

22
Q

Annual incidence of falls is _____ among those who have fallen before

A

Over half

23
Q

___% of falls by older adults result in fx or other serious injury

A

20

24
Q

Most (95%) of ___ fractures are caused by falls

A

Hip (“widow maker”)

25
Q

Falls are the most common cause of ____

A

TBI

26
Q

The death rate attributable to falls ________ w/ age

A

increases

27
Q

Mortality is highest in this population

A

White men aged >85

28
Q

Sequelae of falls

A
  • Decline in functional status
  • NH placement
  • Increased use of medical services
  • Fear of falling (leading to isolation)
29
Q

____ of those who fall are unable to get up without help

A

Half

30
Q

What is a “long lie”?

A

When older adult is found down

31
Q

What lab test do we do in pt. who are found down?

A

CK - looking for rhabdo!

32
Q

A “long lie” predicts

A

Lasting functional decline

33
Q

Balance control requires input from these systems:

A

Visual, vestibular, proprioceptive, tactile & kinesthetic sensation, CNS processing, and execution of motor output

34
Q

Intrinsic RF r/t falls:

A
  • POLYPHARMACY
  • Dizziness
  • Muscle weakness
  • Gait abnormalities
  • MSK, motor control problems
  • Peripheral neuropathy
  • PD, CVA
  • Vestibular disorders
  • Nocturnal urination
  • Decreased vision
  • Previous falls
35
Q

Common clinical problems identified in fall pt.

A

Top three:

  • Neuropathy
  • DJD
  • Pain syndromes
36
Q

List of inappropriate medications in older adults

A

Beer’s list

37
Q

Examples of medications that pose significant risk

A

BZDs, AD’s, AP’s, Anti-HTN, Anti-histamines (esp. diphenhydramine, don’t forget H2 blockers)

38
Q

In regards to medications, the highest risk of falls is r/t

A

of medications pt. is on (regardless of type)

39
Q

Extrinsic RF r/t falls:

A
  • Stairs
  • Poor lighting
  • Clutter
  • Loose throw rugs, slippery surfaces
  • Ill-fitting close, footwear
  • Pets
40
Q

Situational RF r/t falls:

A
  • Rushing
  • Inattention
  • Poor safety awareness
  • Unfamiliarity or hazards
  • Risk-taking behavior (usually r/t cognitive impairment)
41
Q

Fall assessment: history

A
  • Meds
  • Vision
  • Gait & balance
  • Lower limb joint issues
  • Neuro
  • CV
42
Q

Fall assessment: physical exam

A
  • Orthostatics
  • Visual acuity screening
  • MENTAL STATUS (MINI-COG)
  • Cranial nerves
  • Romberg
  • Cerebellar function
  • QUALITATIVE GAIT ASSESSMENT
43
Q

If single fall, check…..

A

For balance or gait disturbance

44
Q

If recurrent fall or (+) gait/balance disturbance, perform…..

A

Complete fall evaluation

45
Q

Routine lab testing in fall pt.:

A

CBC & BMP (exclude anemia, dehydration, hyperglycemia, electrolyte abnormality)

46
Q

Lab test dependent on H&P in fall pt.:

A

ECG, echo, brain imaging (if delirium present), radiographic studies, UA, CXR, TSR, RPR

47
Q

Goals of treatment for falls:

A

Reduce intrinsic & environmental risk factors

48
Q

__________ approach to fall prevention is the most efficacious

A

Interdisciplinary

49
Q

Fall interventions:

A
  • Revise meds
  • Assistive devices (walker, cane, orthotics)
  • Energy conservation
  • Home safety equipment
  • Pt. + caregiver education
  • Alarms
  • Transfer & functional training
  • Therapeutic exercises
  • Behavioral programs
50
Q

What is the stay independent questionnaire?

A

A self-assessment tool for those who are cognitively intact that assesses risk of falls (can be filled out by caregivers if necessary)

Geriatrics 1 (8 decks)

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