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Special Pops - Geriatrics > Falls in the Elderly > Flashcards

Falls in the Elderly Flashcards

1
Q

Falls in the elderly are linked to:

A

Increased morbidity and mortality

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2
Q

Fear of falling can predispose someone to:

A

Future falls

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3
Q

What is going to be investigated for its potential in preventing falls?

A

Balance confidence (perceived self-efficacy)

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4
Q

How many people over 65 fall every year?

A

1 in 3

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5
Q

Those who fall are at least ___ as likely to fall again

A

Twice

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6
Q

How many falls cause serious injury?

A

1 in 5

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7
Q

What % of elderly fear falling?

A

Around 30%

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8
Q

What % of people 65 and over fall in a given year?

A

35-40%

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9
Q

What % of people over 80 yo fall in a given year?

A

50%

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10
Q

What % of people 65 or older visit the ED because of a fall related injury? Of these, how many are admitted?

A

8% with half of these being admitted

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11
Q

Falls account for what percentage of fractures in the elderly?

A

87% of all fractures (and more than 95% of hip fractures)

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12
Q

What are the different types of risk factors for falls?

A

Extrinsic (environmental)
Intrinsic
Predictive

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13
Q

What are intrinsic risk factors for falls?

A
  • Biological: weakness, gait/balance problems, poor vision

- Behavioral: meds, risky behaviors, inactivity, depression, cognitive impairment

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14
Q

Where do most falls occur?

A

In the home (85%)

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15
Q

Environmental risks for falls

A
  • Home clutter/hazards
  • Support surface
  • Poor lighting
  • Clothing
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16
Q

What % of falls occur in the home?

A

85%

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17
Q

If someone has 0-1 risk factors, what is their risk % of falling each year?

A

27%

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18
Q

If someone has 4 or more risk factors, what is their risk % of falling each year?

A

78%

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19
Q

Maintaining balance during body movements requires:

A

A reaction to restore the person’s displaced center of mass over the base of support

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20
Q

What does adequate postural control require?

A

Keeping center of gravity over base of support during BOTH static and dynamic situations

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21
Q

How must the body be able to respond to changes in center of gravity?

A
  • Intentional movement

- Involuntary or unexpected movement (slips, trips)

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22
Q

What factors must integrate in order for postural control to occur?

A

Vision, vestibular and proprioceptive input by the CNS

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23
Q

The area over the feet within which a person is able to lean ____ with age

A

Decreases

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24
Q

What does impaired performance of static balance tasks affect?

A

Walking and transferring

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25
Q

What are the action systems in postural control?

A
  • Higher level planning: frontal and motor cortex
  • Coordination: brainstem, spinal networks coordinating muscle response synergies
  • Generation: motor neurons and muscles
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26
Q

How can changes in postural tone be verified?

A

EMG

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27
Q

How can changes in postural tone be assessed?

A

Changes can be seen in certain anti-gravity muscles during normal upright standing (and can be verified with EMG)

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28
Q

Motor control of quiet stance consists of:

A

Alignment
Muscle tone
Postural tone

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29
Q

Which muscles are activated and contribute to postural tone at rest?

A

Anti-gravity muscles

  • Gastroc/soleus
  • Tibialis anterior
  • Gluteus medius and TFL
  • Iliopsoas
  • Thoracic erector spinae
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30
Q

Why does the gastroc/soleus group activate in postural tone?

A

Line of gravity is anterior to knee and ankle

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31
Q

When does the tibialis anterior activate to maintain postural tone?

A

When body sways backward (opposes the gastroc/soleus)

32
Q

How does the iliopsoas help control postural tone?

A

Prevents hyperextension of hips

33
Q

Why do the thoracic erector spinae muscles activate in postural tone?

A

Line of gravity falls in front of spinal column

34
Q

What affects loss of postural balance in the elderly?

A
  • Speed or magnitude of displacement
  • Inability to quickly detect displacement b/c slowing of CNS sensory into motor response
  • Muscle weakness or joint pain causing slow motor response
35
Q

What affects stance control?

A

Position and velocity of the COM

36
Q

What are the strategies underlying stance postural control?

A

Motor
Sensory
Sensorimotor

37
Q

How do the gluteus medius and TFL contribute to postural tone?

A

Assist with proximal control

38
Q

What strategies are employed to keep anteroposterior stability?

A
  • Ankle
  • Hip
  • Stepping
39
Q

Define ankle strategy

A
  • For anteroposterior stability

- Response to small perturbation on a firm surface

40
Q

Define hip strategy

A
  • For anteroposterior stability

- Response to a larger faster perturbation on a smaller or compliant surface

41
Q

Define stepping strategy

A
  • For anteroposterior stability

- Response to strong perturbation, enough to displace COM outside of BOM

42
Q

Which anteroposterior stability is the response to a STRONG perturbation?

A

Stepping strategy

43
Q

How is central processing affected with age?

A

Neuro diseases can cause impairments (Parkinson’s, stroke, NPH, etc.)

44
Q

What is the consequence of weak hip abductors/adductors in the elderly?

A

Decreased ability to maintain balance while stepping to avoid a fall

45
Q

What foot problems can cause balance issues in the elderly?

A

Calluses and bunions affect sensory skills

46
Q

What factor is more highly correlated with physical function than muscle strength?

A

Muscle POWER

47
Q

How does skeletal muscle change with age?

A
  • Loses both Type I and II fibers
  • Number of motor units declines
  • Number of myelinated fibers declines
48
Q

What shows the greatest decline with age compared with all other joints?

A

Spinal flexibility (d/t spinal stenosis, thoracic kyphosis, cervical spondylosis)

49
Q

What % of 65 and older experience postural hypotension?

A

10-30%

50
Q

Define postural hypotension

A

Drop in SBP of 20 mmHg or more with change in position from lying to standing

51
Q

What causes postural hypotension?

A
  • Meds
  • Dehydration
  • Age associated changes affecting autonomic control of vascular tone
52
Q

Define “self-efficacy”

A

A person’s perception of their ability to master a given type or level of performance in certain settings

53
Q

Define “fear of falling”

A

A diminished perceived self-efficacy at preventing a fall during normally non-hazardous activities of daily living

54
Q

Reduced self-efficacy for balance can lead to:

A
  • Self imposed restrictions to activity
  • Deconditioning and loss of muscle mass
  • Fall-related anxiety producing muscle tension
55
Q

Fear of falling is a predictive risk factor for:

A
  • Poorer quality of life
  • Functional decline
  • Loss of independence
56
Q

What are objective screening measures of fall risk?

A
  • Berg Balance Scale
  • Timed Up and Go Test
  • Activities Specific Balance Confidence Scale
57
Q

What is the ABC scale?

A

16 item scale that detects loss of balance confidence

58
Q

What is the Berg Balance test?

A
  • 14 items to assess balance, rated by an observer

- CANNOT use assistive device

59
Q

What is the Timed Up and Go test?

A

Time it takes to go from sitting to standing, walk 3 m and returning to sitting

60
Q

Scoring of ABC scale?

A
  • Less than 50% indicate low level physical functioning
  • 50-80%: moderate
  • Over 80%: high functioning
61
Q

What ABC score indicates a falls risk?

A

67% with about 85% sensitivity/specificity

62
Q

Benefits of the ABC score

A
  • Provides insight into “fear of falling” syndrome

- Facilitates active participation in interventions for falls risk reduction

63
Q

Limitations of the ABC scale

A
  • Not appropriate for all settings (some activities may not have been experienced by the participant)
  • Not a replacement for physical performance measures
64
Q

What does the Timed Up and Go test assess?

A

Examines functional mobility in community dwelling older adults 70-84 yo

65
Q

What TUG test result indicates high risk for fall?

A

Longer than 14 seconds

66
Q

Disadvantages of TUG test

A
  • Instructions for the test vary
  • Inconsistent start of timing
  • Measurement error
67
Q

Benefits of Berg Balance test

A
  • Well known
  • May detect cognitive impairment
  • Found to be a valid measure in many populations including stroke pts
  • Low cost
68
Q

How to interpret Berg Balance test score?

A
  • Many use 45 (out of 56) as a cutoff score to indicate impaired balance
  • Some use ranges 41-56 as low risk, 21-40 medium, 20-0 high risk
69
Q

What cut off time of the Five times Sit to Stand test indicates fall risk?

A

13 seconds

70
Q

What gait speed indicates being more dependent in one or more ADLs?

A

0.25 m/s

71
Q

What gait speed is needed for elderly to cross street safely?

A

More than 1.0-1.2 m/s

72
Q

What is the benefit to learning how to fall?

A
  • More likely to roll with impact
  • LEAST amount of injury
  • Key is relaxation
73
Q

Describe difficulty getting up after a fall

A
  • Associated with substantial morbidity
  • 51% in the community unable to get up unassisted
  • 85% NOT a/w serious injury
  • Over 20% remain on floor for over 1 hour
74
Q

How is physical restraint used to reduce falls in hospital?

A

LAST RESORT - not been shown to decrease incidence of falls

75
Q

A decrease in 1 SD of femoral neck bone mineral density increases the risk of hip fracture ___ times

A

2.7

Special Pops - Geriatrics (9 decks)

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