Falls in the elderly - Dr Lai - Geriatrics Flashcards
Falls in elderly is important in the following:
- Disability
- intitutionalisation - Prolonged hospital stays - increased costs
- mortality (increased)
- Socioeconomic burden -(e.g familes having to look after parent, costs)
Some statistic regarding falls:
How do rates of fall vary by age?
How do they vary by gender?
How do deaths vary by age? How do deaths vary by gender?
Overview of the cost of falling:
How much of falls lead to severe injuries? What does this lead to?
What other important factors must we consider!? (psychological)
- fear of falling
- avoidance of social
Why do older people fall? – What are the factors leading to a fall?
Instrinsic vs Extrinsic factors?
What are the strongest predictor of falls???!
Intrinsic factors for falls? (LIST 6 FACTORS)
1.
- Foot deformities
- sensory neuropathies (depth perception altered)
- Motor problems, balance and gait
- Visual impairment!!
- Sensory impairment- peipheral neuropathy, vestibular dysfunction, vision!
- Cognitive impairment- Risk taking behaviour for ones own ability - Dementia, gait, apraxia, delirum!
- Age frailty: barrier to self awareness- under estimates risks-
- MEDICAL conditions!
- Medications
- Chronic pain
- Orhtostatic hypotension
- fALLS CAN BE CAUSED BY: Subdural/CVA/TIA/Syncope -arrythmias!
What are extrinsic factors for FALLS? (outside factors, e.g polypharmacy)
- Polypharmacy -pyschotropic-sedatives
- Substance abuse - increasing in the elderly - increased risk of delirium (ETOH especially)
- Unbalanced grounds, curbs,
- Environmental factors - loose rugs, poor lighting
- Mobility aids- increased risk of falls
Management approach:
How do we assess these patients: History (all events around the fall), associated symptoms, screen for other conditions, identitfy the complications, screening geriatric syndrome
Physical examiantion
Investigation:
What important, Pmhx, social hx, medication review? (FALLS)
Physical examination for falls: Each system? What are you looking and asking about?
What investigations are important in falls? Bedside, Bloods, Imaging
History:
- circumstances relating to fall?
Investigation
81 year old lady- breakdown of case:
Hx, Associated symptoms, DDx, Possible complications?
What are the possible complications from this fall?
- Pain
- ICH
- Fractures
- Soft tissue injury-haemotoma
- Long lay down- and Rhabdomyolysis
- Hypoglcaemia - T2Dm
- Delirium (age and risk factors)
How do we screen for Geriatric syndromes? Why are these so important?
What is the comprehensive Geriatric Assessement?
What are the important things we must cover in physical examination (ask vision, hearing, dizziness, Arrythmia, postural Bp!!!!, MSK, Neuro, Gait, Cognitive assessment
What cognitive tests should be done?
What are important delirum screening tests?
MMSE, GPCOG
4ATs
CAMs
What important investigations should be completed and what should be considered?
How do we best manage these patients?
MDT approach is needed!
Target modifible risk factors?
Optimise medicakl conditions, medication review, mobility and funcitonal assessment (HOME SAFETY)
What are two good screening balance test that can help you identify deficits who will benefit from an excercise program
Management approach: Stepwise multidimensional targeted interventions?
1) Inpatient management
2) Transition to home - Liasing with rehab, Community services
2) Post Discharge D/C care- Ongoing community allied health input - Optimizing bone health, Adding sustainable community services (dietian, social worker, OT, physiotherapy,
What are important Post discharge management considerations?
Management continued - BONE health- vit d
What is medication rationalisation(decreasing meds in oldies)
What are important post d/c services for elderly?
Why is MDT so important in management
What are important factors that we need to know for these patients (multifactorial+ Step wise approach)
What are key management strategies for patients following a fall?
(think all systems- and how to implement management strategies)
