Falls in Elderly

Question 1

A fall can be defined as the following:

• Unintentional, unexpected loss of balance
• Coming to rest on the ground or floor or on object below knee level
• A person’s centre of mass goes outside of their base support

What is the number of >65y/o who fall at least once a year?

1 - 1 in 10
2 - 1 in 8
3 - 1 in 5
4 - 1 in 3

Answer 1

4 - 1 in 3
- this is 1 in 2 in >80 y/o

Question 2

A fall can be defined as the following:

• Unintentional, unexpected loss of balance
• Coming to rest on the ground or floor or on object below knee level
• A person’s centre of mass goes outside of their base support

Falls are the most common cause of injury related death in what age category?

1 - >55 y/o
2 - >65 y/o
3 - >75 y/o
4 - >585 y/o

Answer 2

3 - >75 y/o
- estimated to cost £2.3 billion/year, more than STEMI (£1.1 million) and slightly less than strokes (£2.8 billion)

Question 3

All of the following are causes of falls, but which is the most common cause, accounting for >40% of falls?

1 - Incorrect shifting of bodyweight
2 - Trip or stumble
3 - Loss of external object support
4 - Hit or bumped
5 - Loss of consciousness or collapse

Answer 3

1 - Incorrect shifting of bodyweight

ACE mnemonic is used:
- Age related changes
- Co-morbidities (Incl. Medications)
- Environment

Question 4

Ageing can cause eye and neurological changes. Which of the following would NOT be associated with an increased risk of falls?

1 - increased number of neurons
2 - increased demyelinated neurons causing slower processing speed and increased latency
3 - Sensory impairment (fine touch / vibration/proprioception)
5 - Impairment of vestibular system

Answer 4

1 - increased number of neurons
- loss of neurons is more common

• overall an inability of the nervous system to respond to people falling is key

Question 5

Posture can change leading to:

• Lumbar lordosis
• Thoracic kyphosis
• Cervical lordosis

Why can these posture changes increase the risk of falls?

1 - weaker back muscles to contract
2 - stronger abdominal muscles that pull forward
3 - shift in centre of gravity forwards
4 - all of the above

Answer 5

3 - shift in centre of gravity forwards
- patients are therefore more prone to falling forwards

Question 6

Can medications increase the risk of falls?

Answer 6

• yes
• lots of drugs can increase the risk of falls

Question 7

Is speaking to the patient and getting a collateral about the patients house important?

Answer 7

• yes
• clutter in the house can cause the falls

Rails
Headroom and clearance
Rugs & carpets
Clothing & footwear
Mobility aids
Lighting

Question 8

Patients can suffer with fractures or head injuries from a fall. But they can also experience psychological trauma. Which of the following can be caused by a patient having a fall?

1 - Fear of more falls
2 - Reduced confidence
3 - Loss of independence
4 - Low mood/depression
5 - all of the above

Answer 8

5 - all of the above

• there are also a list of secondary problems as well:
• Chest infection
• Pressure sore
• Dehydration
• Muscle Atrophy
• Pain
• Burns
• Hypothermia