Falls in older people Flashcards
What is a fall?
Non-intentionally coming to rest at a lower level
What are the consequences of falls in older adults?
Biologica, psychological and social
What time of day do most falls happen?
Noon - 6pm
Midi-afternoon dip in energy/concentration
Name some intrinsic factors of cause of falls.
Syncope / transient LOC - many causes Dizziness or vertigo Seizures Peripheral neuropathy Stroke Visual impairment Parkinson’s disease Cognitive impairment - affects assessment of risk Side effects of drugs or alcohol Age-related frailty (e.g. joint problems, muscle weakness)
What is syncope?
Sudden, transient loss of consciousness due to reduced cerebral perfusion
Unresponsive, loss of postural control
Spontaneous recovery
Which of these is not a common cause of syncope?
Pain and TIA?
TIA - they cause focal deficit, unless brainstem ischaemia
What are some causes of syncope?
Situational hypotension – posture, coughing, eating (esp. orthostatic hypotension)
Vasovagal – vagal stimulation (pain, fear, emotion)
Carotid sinus syndrome
Cardiac arrhythmia or ischaemia
Outflow obstruction – aortic stenosis
Pulmonary embolism
Name some extrinsic factors of falls.
Poor lighting – especially steps/stairs
Clutter around the home
Inappropriate footwear - esp. open-backed slippers, high heels
Incorrect use of walking aids
Pets or children
Trailing cables
Slippery floors or pavements
Rugs & carpet folds
Bath / toilet problems - esp. too low, slippery, lack of handles
Unfamiliar environment - esp. hospital, care home
What are the common causes of falls? (DAME)
Drugs
Age-related changes
Medical
Environment
Which mnemonic can you use when assessing falls? (History)
SPLATTD Symptoms Previous falls Location Activity Time Trauma sustained Drug history
What examinations can you do to assess a fall?
General appearance
Gait & balance
Pulse rate & rhythm
Postural BP
Consider carotid sinus massage (expert only!)
Listen for murmurs – esp. aortic stenosis
Neurological examination
Look for signs of Parkinson’s disease
Check vision & hearing
Examine neck & head movements
Consider screening for cognitive impairment
What is orthostatic hypotension?
“postural hypotension” >20 mmHg fall in systolic BP and/or >10 mmHg fall in diastolic BP within 3 minutes of standing with symptoms
What is Post-prandial hypotension?
A fall of > 20 mmHg in systolic blood pressure after the ingestion of a meal
What kind of visual impairment can cause falls in older adults?
Bifocals increase the risk of falling Glaucoma Macular degeneration Retinopathy Cataracts
What investigations can you do for falls in older adults?
Bloods: FBC, Us and Es, TSH, Glucose, B12, folate, calcium, phosphate BP ECG Echocardiography EEG CT of head
