Falls, Immoblity, and ADLS Flashcards
Best predictor of falling = _____
Previous fall
_____ → 70% of accidental deaths in patients > 75 yo
Falls
GOALS with a Fall evaluation
- Treat acute injuries, seek emergent care if needed
- Obtain a thorough H&P in order to determine likely etiologies
- Create evaluation & management plan
What are common acute injuries that
result from geriatric falls?
- Wrist fractures
- Ankle fractures
- Hip fractures
- Lacerations/contusions
- Head injuries
T/F An Isolated fall is not
always a sign of a
major problem
T
Recurrent falls =
> 2 falls in a 6-month period
Asked about falls or
mobility problems at least
_____
once per year
“72-hour rule”
Medicare’s 3-day
payment window for
outpatient services
that hospitals and
hospital wholly owned
or wholly operated
Part B entities furnish
to Medicare
beneficiaries
Open-ended questions when gathering a fall history
● Ingestions?
○ Medications, herbal supplements, substances, ETOH
● Witness to the fall?
○ Pt, witnesses &/or caregivers
■ Inquire about details about this & previous falls
● Who is available to assist the patient?
● Was the pt able to get backup without help after falling?
Recommendations for exercise in elderly patients
- ↓ falls by 58% compared to
stretching or multimodal exercise - ↑ walking speed & physical
function - ↑ balance confidence
Decubitus Ulcers
● An area of unrelieved pressure over
a defined area bony prominence ↓ Ischemia, cell death, tissue necrosis
Etiology of pressure ulcers
- Impaired mobility
- Inability to perceive pain
- Skin atrophy
- Incontinence
- Malnutrition
Pathophysiology of pressure ulcers
- Constant pressure sufficient
to impair local blood flow to
soft tissue for an extended
period - Maceration predisposes
to injury - Compression of the tissues
against an external object
Review the staging of pressure ulcers
Slides 36-37
Diagnostics for a pressure ulcer
Labs
● CBC c diff
● ESR
● Imaging
○ Plain films, bone scans, MRI
Tissue biopsy
● Non-healing wounds despite
adequate care
● Bacterial infection is suspected
● Bone biopsy
○ Gold standard = Dx osteomyelitis
