Falls in the Elderly Flashcards
What are some differential diagnoses for falls?
- trip
- UTI
- respiratory infection
- stroke
- COPD exacerbation
- sub-arachnoid haemorrhage
Questions to ask regarding a fall?
When did it occur? What were you doing at the time? Where did it happen? Any symptoms prior to fall? LOSS OF CONSCIOUSNESS? Any injuries? What happened after? Did they regain consciousness quickly? How many falls last 6 months?
What is syncope?
A transient loss of consciousness characterised by fast onset and spontaneous recovery.
Wha causes syncope?
Reduced perfusion pressure in the brain
How is syncope managed?
It’s usually self-limiting. Being horizontal will fix low blood pressure.
What are common symptoms preceding syncopal episodes?
- light headedness
- sweating
- pallor
- blurred vision
Are seizures and syncope the same?
No. A generalised tonic-clonic seizure is a loss of consciousness and will cause a fall.
How is syncope categorised?
1) Reflex syncope
2) Orthostatic syncope
3) Cardiac/Cardiopulmonary Disease
What is a Reflex Syncope?
A disorder of the autonomic regulation of postural tone. Activation of part of the the medulla leads to decrease in sympathetic output and increase in parasympathetics. This causes reduced HR -> reduced CO and BP chasing reduced cerebral perfusion.
What’s an example of a reflex syncope?
- Vasovagal-‘simple faint’-from prolonged standing, stress, sight of blood, pain
- Situational syncope e.g. coughing, straining, lifting heavy weight
- Carotid sinus massage
What is Orthostatic Hypotension?
A drop of 20mmHg or more, with pre-syncopal symptoms on standing (usually from a sitting or lying position).
Why does standing up cause Orthostatic hypotension?
Standing up causes 500-800ml of blood to pool in the legs, which reduces the EDV. Reduced EDV means less cardiac stretch, and thus reduced stroke vol. and cardiac output. Usually managed by the baroreceptor reflex, if this fails then cerebral perfusion will drop and syncope occurs.
Explain the baroreceptor reflex for high BP
High BP = reduced baroreceptor activity = reduced SAN activation = reduced ventricular muscle contractility
Explain the baroreceptor reflex for low BP.
Low BP = increased baroreceptor activity = increased SAN activation = increased ventricular contractility
Why does the baroreceptor reflex fail?
- Baroreceptors become less sensitive with age and hypertension.
- Medications, such as anti-hypertensives can impair this response, or venous return.
- Dehydration
What is cardiac syncope?
Syncope caused by cardiac disease or abnormality. Can be an electrical (rhythm), structural or coronary cause.
What kinds of electrical cardiac abnormality can cause syncope?
- Bradycardias
- Tachycardias
What kind of structural cardiac abnormalities can cause syncope?
- Aortic stenosis
- Hypertrophic Obstructive Cardiomyopathy
What kind of coronary disease can cause syncope?
MI/IHD
What is Aortic Stenosis
Narrowing of the aortic valve
How does Aortic Stenosis cause syncope?
Narrowing of the aortic valve means it’s harder to push blood through it, which means the heart has to work harder. During exercise especially this means that there isn’t adequate perfusion of the brain.
What is the mean survival of patients with aortic stenosis with syncope?
2-5yrs untreated
Features of Cardiac Syncope?
- Exertional syncope
- Family history of cardiac disease or sudden cardiac death
- Preceeding chest pain or palpitations
- Past medical history of heart disease
- Abnormal ECG
Which drugs induce drowsiness?
Benzodiazepines
Anti-depressants
Anti-psychotics
