Frailty & Falls

Question 1

what is frailty

Answer 1

a progressive physiological decline in multiple organ systems marked by loss of function, physiological reserve, and increased vulnerability to disease and death

Question 2

what are some age-realted physiological changes related to frailty?

Answer 2

changes in autonomic function & cellular homeostasis
decrease in organic mass
reduction in functional reserve

Question 3

frailty is determined by presence of >3 of the following:

Answer 3

unintentional weight loss (>10lb)
self-reported exhaustion
weakness (diminished grip strength)
slow walking speed
decreased PA

Question 4

what two scales are used to assess frailty

Answer 4

edmonton frail score
clinical frailty scale

Question 5

what are some interventions you can use to mitiage frailty

Answer 5

medication & nutrition review
exercise
sleep
reduce stress
assistive equipment
referrals

Question 6

what is the definition of a fall

Answer 6

unexpected event in which an individual comes to rest on the ground, floor, or lower level

Question 7

are causes of fall intrinsic or extrinsic?

Answer 7

BOTH
intrinsic - balance, gait, vision, orthostatic hypotension, syncope, depression, cognitive impairment
extrinsic - slip, trip, meds, alcohol

Question 8

how often should you screen people for falls?

Answer 8

annually for people >=65 for 2+ falls/year, balance or gait difficulties

Question 9

what is the leading cause of TBI in the elderly?

Answer 9

falls - especially in women

Question 10

what tools can be used to assess falls risk

Answer 10

FRAT
gait and balance assessment (Berg Balance Assessment)
Timed Up and Go (TUG)

Question 11

what should be included in a comprehensive assessment for falls?

Answer 11

BP, neuro, vision, feet/footwear, medical, cognitive, meds, bone health, pain, environmental, QOL

Question 12

what is included in management of falls

Answer 12

exercise programs
osteoporosis treatment
CEP - falls prevention and management

Question 13

What are some important considerations regarding TBI in the elderly

Answer 13

as the brain atrophies with age, more space created so more blood accumulates before symptoms appear

polypharmacy - drug interactions, anticoagulants

comorbidities (CVD, diabetes, hx TBI)

CGS may be less useful with pre-existing dementia

Head CT if >65 always

higher risk fo epilepsy (especially if AD), dementia and PD

Question 14

how is concussion diagnosed

Answer 14

clinical dx, no biomarker

Question 15

what are initial symptoms of concussion

Answer 15

Loss of consciousness, confusion, headache, nausea, amnesia, vomiting, dizziness, blurred vision, poor concentration

Question 16

what are later symptoms of concussion

Answer 16

fatigue, depression

Question 17

what are VERY late symptoms of concussion

Answer 17

dementia, suicide

Question 18

what is the treatment for concussion

Answer 18

quiet time x 24 hrs, then return to learn/work
exercise