Falls & Gait Evaluation Flashcards
Ask ALL pt:
Have you had any falls in the last year?
Example of a gait assessment tool
Get up & go
Most gait disorders ARE or AREN’T associated with underlying disease
ARE
Important component of neurological exam
Describing pt. gait
How to perform the get up & go test
Risk from a chair w/ arms, walk 10 feet, turn, return to chair & sit down
Most adults can complete the get up & go in ____ seconds
10-12
A get up & go test of ___ seconds indicates increasing risk for falls
> 14
A get up & go test of ___ seconds indicates HIGH risk for falls (more comprehensive eval indicated)
> 20
Results of the get up & go are strongly associated with……
Functional independence of ADLs
Reduction in gait speed is ass. w/
Poorer health status, poorer physical functioning, more disabilities, additional rehab visits, longer hospital stays, high costs
*Increase in speed has the opposite effects!!
How do we measure comfortable gait speed?
Timed walk
Conditions that contribute to gait disorder
- 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)
________ is not a common cause of falls
Syncope (own entity, NOT a multifactorial event -> what we’re worried about)
Antalgic gait
Shortened phase of gait on painful side; pain-induced
Circumduction gait
Outward swing of leg ass. w/ neurologic disorder
Festination gait
Acceleration of gait; PD pt.
Foot drop
Loss of ankle dorsiflexion; indication for orthotic evaluation
Trendelenburg gait
Weakness in pelvic stabilizing muscles -> affected hip drops w/ step (supposed to lift); r/t myopathy
Fall definition
Coming to rest inadvertently on the ground or at a lower level
___ of older adults reported a fall (2014)
A quarter
Leading cause of death from injury in persons aged >65
Falls
Annual incidence of falls is _____ among those who have fallen before
Over half
___% of falls by older adults result in fx or other serious injury
20
Most (95%) of ___ fractures are caused by falls
Hip (“widow maker”)
Falls are the most common cause of ____
TBI
The death rate attributable to falls ________ w/ age
increases
Mortality is highest in this population
White men aged >85
Sequelae of falls
- Decline in functional status
- NH placement
- Increased use of medical services
- Fear of falling (leading to isolation)
____ of those who fall are unable to get up without help
Half
What is a “long lie”?
When older adult is found down
What lab test do we do in pt. who are found down?
CK - looking for rhabdo!
A “long lie” predicts
Lasting functional decline
Balance control requires input from these systems:
Visual, vestibular, proprioceptive, tactile & kinesthetic sensation, CNS processing, and execution of motor output
Intrinsic RF r/t falls:
- POLYPHARMACY
- Dizziness
- Muscle weakness
- Gait abnormalities
- MSK, motor control problems
- Peripheral neuropathy
- PD, CVA
- Vestibular disorders
- Nocturnal urination
- Decreased vision
- Previous falls
Common clinical problems identified in fall pt.
Top three:
- Neuropathy
- DJD
- Pain syndromes
List of inappropriate medications in older adults
Beer’s list
Examples of medications that pose significant risk
BZDs, AD’s, AP’s, Anti-HTN, Anti-histamines (esp. diphenhydramine, don’t forget H2 blockers)
In regards to medications, the highest risk of falls is r/t
of medications pt. is on (regardless of type)
Extrinsic RF r/t falls:
- Stairs
- Poor lighting
- Clutter
- Loose throw rugs, slippery surfaces
- Ill-fitting close, footwear
- Pets
Situational RF r/t falls:
- Rushing
- Inattention
- Poor safety awareness
- Unfamiliarity or hazards
- Risk-taking behavior (usually r/t cognitive impairment)
Fall assessment: history
- Meds
- Vision
- Gait & balance
- Lower limb joint issues
- Neuro
- CV
Fall assessment: physical exam
- Orthostatics
- Visual acuity screening
- MENTAL STATUS (MINI-COG)
- Cranial nerves
- Romberg
- Cerebellar function
- QUALITATIVE GAIT ASSESSMENT
If single fall, check…..
For balance or gait disturbance
If recurrent fall or (+) gait/balance disturbance, perform…..
Complete fall evaluation
Routine lab testing in fall pt.:
CBC & BMP (exclude anemia, dehydration, hyperglycemia, electrolyte abnormality)
Lab test dependent on H&P in fall pt.:
ECG, echo, brain imaging (if delirium present), radiographic studies, UA, CXR, TSR, RPR
Goals of treatment for falls:
Reduce intrinsic & environmental risk factors
__________ approach to fall prevention is the most efficacious
Interdisciplinary
Fall interventions:
- Revise meds
- Assistive devices (walker, cane, orthotics)
- Energy conservation
- Home safety equipment
- Pt. + caregiver education
- Alarms
- Transfer & functional training
- Therapeutic exercises
- Behavioral programs
What is the stay independent questionnaire?
A self-assessment tool for those who are cognitively intact that assesses risk of falls (can be filled out by caregivers if necessary)
