Falls in the Elderly Flashcards
What is a fall?
Event which causes a person to unintentionally rest on the ground and is not the result of a major intrinsic event, e.g. stroke, or overwhelming hazard ≈ must be pure fall
List the Geriatric Giants (frailty syndromes)
Immobility
Incontinence
Incompetence
Impaired homeostasis
Iatrogenic disorder
Which of the following is not a Geriatric Giant?
A. Iatrogenic
B. Incompetence
C. Immobile
D. Incongruence
D. Incongruence
Which of the following is not a Geriatric Giant?
A. Iatrogenic
B. Impaired homeostasis
C. Incontinence
D. Intelligence
D. Intelligence
What is Frailty?
distinctive health state related to ageing process in which multiple body systems gradually lose their in-built reserves which is not static but dynamic, treatable and not inevitable aspect of ageing
What are the prevalence and incidence of falls?
- 1/3 in over 65s
- 250 000 people fall in hospital each year in UK
List 3 different healthcare settings where care may be received and explain how each may affect healthcare outcomes. Give 4 examples for each.
- Hospitals
- Acute/Community hospitals
- Intermediate care
- Nursing home
- Home (Community)
What are fragility fractures?
Fx sustained from a low energy fall from standing height or less and previous fracture doubles risk of future fractures. The fracture causes excess morbidity associated with the fracture event and may reduce their level of independence and functionality greater than a non-frail adult
On an X-Ray, what line can guide you as to whether there is a hip fracture?
Shenton’s line (inferior border of superior pubic ramus to neck of femur ≈ NOF Fx or DDH) + Hilgenreiner’s Line ( horizontally through inferior aspect of triradiate cartilages ≈ shows acetabular angle) + Perkin’s Line (perpendicular to Hilgenreiner’s line, intersecting lateral aspect of acetabular roof ≈ upper femoral epiphysis seen in inferomedial quadrant, below Hilgenreiner’s line and medial to Perkin’s line.
What three types of hip surgery are there?
1) Hemiarthroplasty
2) Total hip arthroplasty
3) Dynamic Hip Screws
List the potential consequences of a fall on a patient.
Fx
Intracranial haemorrhage (Subdural/Epidural)
Rhabdomyolysis
Psychological impact
What is a subdural haematoma?
serious condition where blood collects between the dura mater and surface of the brain usually caused by a head injury
Give 3 clinical features of a subdural haematoma
- Cerebral atrophy
- Delirium
- Focal neurological deficit
- Headache
- Falls
- Seizures
What are the psychological impact(s) of a fall?
- Loss of confidence
- Fear of leaving house
- Reduced mobility
- Increased dependence
- Fear of long lie (only 50% can get up following fall)
What are the red flags for a long lie following a fall?
Only 50% of people are able to get up from ground following fall
- Weakness - Illness - Social isolation - Fear of falling - Muscle damage - Pneumonia - Pressure sores - Dehydration - Hypothermia
What three categories of factors can contribute to a fall? Give an example for each.
- Individual: Immobility/Impaired homeostasis/Illness/Vision/Eyesight
- Activity: Lower threshold for activity to occur
- Environment: Hazards etc
How can causes of falls be stratified?
1) Intrinsic
- Transient cause: not usually present in individual e.g. UTI, chest infection, cellulitis
- Pre-existing but reversible: e.g. OH, poor balance, strength, abnormal gait, poor vision, continence, fear of falling
- Pre-existing and not reversible: advanced dementia, amputation, history of previous falls
2) Extrinsic: Often modifiable and may help mitigate non-modifiable intrinsic risks
- Carpets, cables, pets
- Footwear
- Stairs
- Poor lighting
- Not using walking aid
- Unfamiliar environment
List 5 consequences of ageing
Cerebral atrophy Sarcopenia Reduced stepping height Decreased sensory function Decreased motor function Frailty Reduced bone density (OP) Reduced vascular function Reduced GFR Reduced body orientation
How may a disease of the bone predispose a patient to increased fracture risk? Give an example.
OP –> hypomineralisation ≈ porosity ≈ increased Fx
Osteopetrosis –> hyper mineralisation ≈ reduced Fx %
List 5 diseases associated with Vertigo
- BPPV
- Meniere’s Disease
- Labyrinthitis
- Stroke
- Migrainous vertigo
- MS
- Acoustic neuroma
How would you examine a patient who has recently had a fall?
Pulse + BP Heart sounds CNS signs Gait Vision Cognition
Give a method of assessing a patient’s gait
Gait test
Timed Up and Go Test
Give 5 investigations you may conduct in a patient with a fall.
FBC
U+E
TFTs
Lipid panel
ECG
EEG
CT/MRI-B
What is frailty?
Clinically recognizable state of increased vulnerability resulting from age-associated decline in reserve and function across multiple physiological systems which reduce the ability to cope with every day or acute stressors
Give 3 features of Realistic Medicine.
- Holistic Approach: Whole-person
- Patient involvement in decisions: ICE + Empowered
- Health literacy – risks vs benefits
- Decision-making
- Potential for harm in over/under-investigation and treatment
Give 3 theories of the Ageing Process
- Genetics: Molecular –> Epigenetics: Acetylation/Methylation
- Genetics: Cellular
- Telomere shortening
- Free radical accumulation
- Apoptosis - Environmental
- Exposure to damage
- Cumulative DNA damage - Evolutionary
- Disposable soma
- Energy Expenditure Theory
Give 3 examples of declines in organ function as we age.
- Reduced visual acuity
- Reduced neuronal connections/pathways –> Cerebral atrophy
- Reduced olfaction
- Reduced neuronal conduction
- Reduced audition
- Reduced GI function
- Reduced GFR
- Reduced CO
- Reduced breathing capacity
Outline the change in population structure which has been experienced in modern times.
- Demographic Transition Model with Developed Economies –> Kite-shaped/Diamond shaped
- Increasing age ≈ increasing morbidities
Give 3 challenges in the Healthcare of Older Patients.
- Healthcare costs
- Social care costs
- Associations with different wealth classes within ageing population (income/activities/lifestyle choices/alcohol/diet/smoking/ACEs)
Accept any other relevant answer
