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SUMGERI > GERI-FaLLs > Flashcards

GERI-FaLLs Flashcards

1
Q

What things are included in mobility?

A

-walking -climbing stairs -getting in/out of cars -transfers: to and from bed, to and from a chair, to and from a wheelchair -getting up from the floor

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2
Q

What percentage of community dwelling elders have difficulty walking?

A

SNF- 40%, CA-8-19%,All >85-54%

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3
Q

How does gait change with advanced age?

A
  • decline in gait speed
  • stride length diminishes
  • not due to decrease in cadence
  • balance declines
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4
Q

What are common gait charcteristics of 80yos?

A
  • shorter, broader strides
  • longer stance (wider)
  • shorter swing duration
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5
Q

What common diagnoses can leading to a gait disorder?

A
  • DJD (arthritis)
  • sensory impairment (DM)
  • neurological disease -stroke, Parkinson’s
  • postural hypotension/rx induced
  • fear of falling
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6
Q

What are the typical gait characteristics of sensory ataxia?

A
  • sensorimotor level: peripheral; from posterior column & peripheral nn.
  • gait: unsteady, esp w/out visual input
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7
Q

What are typical gait characteristics of vestibular ataxia?

A

unsteady, weaving (“drunken”)

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8
Q

What are typical gait characteristics of visual ataxia?

A

tentative, uncertain

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9
Q

What are typical gait characteristics of arthritic conditions (antalgic, joint deformity)?

A
  • avoids weight bearing on affected side, shortens stance phase
  • painful hip may produce Trendenlenburg gait
  • painful knee is flexed
  • painful spine produces short, slow steps and decreased lumbar lordosis
  • contractures, deformity-limited motion, buckling with weight bearing
  • kyphosis and ankylosing spondylosis produce stooped posture
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10
Q

What are typical gait characteristics for myopathic and neuropathic (weakness) abnormalities?

A
  • pelvic girdle weakness produces exaggerated lumbar lordosis and lateral trunk flexion
  • proximal motor neuropathy produces waddling and foot slap
  • distal motor neuropathy produces distal weakness exaggerated hip flexion, knee extension, foot lifting and foot slap
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11
Q

What are typical gait characteristics of hemiplegia/paresis?

A
  • leg swings outward and in semicircle from hip

- knee may hyperextend and ankle plantar flex and invert

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12
Q

What are typical gait characteristics of paraplegia/paresis

A
  • both legs circumduct,
  • steps are short shuffling and scraping
  • if severe, hip adducts so that knees cross in front of each other
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13
Q

What are typical gait characteristics of Parkinsonism

A
  • small shuffling steps, hesitation, acceleration, falling forward, falling backward
  • moving the whole body while turning (en bloc), absent arm swing
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14
Q

What are typical gait characteristics of cerebellar ataxia?

A

wide-based with increased trunk sway, irregular stepping, staggering, esp on turns

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15
Q

What are typical gait characteristics of cautious gait?

A

fear of falling with appropriate postural responses, normal to widened base, shortened stride, decreased velocity, en bloc turns

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16
Q

What are typical gait characteristics of cerebrovascular, NPH (frontal-related gait d/os)

A

frontal gait d/o: difficulty initiating gait and short shuffling gait similar to Parkinson’s but wider base, upright posture, preservation of arm swing, leg apraxia, may freeze w/ diversion of attention or turning may also have cognitive, pyramidal, and urinary disturbances

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17
Q

What are some consequences of gait abnormalities?

A
  • functional decline
  • for community dwelling elders, predict higher risk of institutionalization
  • increased morbidity and mortality **
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18
Q

-drop in pelvis/weight to unaffected side- gluteus medius hip abductor weakness

A

Trendelenburg gait

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19
Q

-backward trunk lurch persists to maintain center of balance -cause: hip extensor weakness

A

Gluteus maximus lurch

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20
Q

-excess hip flexion to clear foot -cause: foot drop (common fibular n); can’t dorsiflex

A

Steppage gait

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21
Q

-unsteady, uncoordinated, wide base, feet thrown out coming down on heel then toes -
cause injury to cerebellum, sensory deficits of lower limb

A

Ataxic gait

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22
Q

-short stance 2/2 pain

A

Antalgic gait

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23
Q

What are the annual fall rates for elderly pts?

A

33% community dwelling elderly

50% nursing home residents 50% sustain injury

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24
Q

What are some of the MCC of falls?

A
  • accident/environment
  • gait/balance d/o
  • dizziness
  • drop attack (syncope)
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25
Q

Common risk factors for falling

A
  • hx of falls
  • gait and balance deficit
  • strength deficit
  • restraints
  • arthritis
  • uses assistive devices
  • impaired ADLs
  • depression
  • cognitive impairment
  • postural hypotension
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26
Q

What is important PMH to obtain in a pt who has fallen?

A 
-hx of injuries, accidents -
falls w/in last 12mos 
-hx of diseases and surgeries 
-hx of orthopedic procedures 
-hospitalizations
 -medications
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27
Q

What are common medications that can contribute to falls?

A
  • polypharmacy in general
  • sedative hypnotics
  • antidepressants
  • antihypertensives
  • cardiac meds
  • hypoglycemic agents
  • topical eye medications
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28
Q

ROS for someone who has fallen

A

-syncope? -
visual impairment? -
SOB? CP?
-neurological? –> sensory deficit, muscle weakness or pain, poor balance

29
Q

What associated symptoms to ask about in a pt who has fallen?

A
  • dizziness
  • light-headedness
  • vertigo
  • syncope
  • weakness
  • confusion
  • palpitations,CP
30
Q

What are recurrent falls usually a result of?

A

-frequently due to to the same underlying cause
-can also be an indication of disease progression (parkinsonism, dementia, HF)
new acute problem

31
Q

Important components of a post-fall assessment

A
  • details of the fall (SPLATT)
  • trauma check
  • postural hypotension
  • determine fall risk factors
  • check incident reports
32
Q

Important social/environmental history to obtain in a pt who has fallen

A

-home: multilevel/stairs, pets, hazards (rugs,cords, poor lighting)
-lives alone?
-assistive device? -
frequently leaves home?
-can they get in and out of the car?

33
Q

How do we treat someone who has fallen in a SNF?

A 
-neuro check q1hr x4 then q4hr x 24hr, 
check VS, 
check FSBS -PE: BP, HR, bruits?, nystagmus, CNx10, muscle testing,
 MMSE 
-PT/OT to evaluate pts home
34
Q

How can syncope contribute to a fall?

A

causes: reduced flow through cerebral blood vessels, reduced CO, impaired oxygenation, peripheral vasodilation, diminished venous tone, leading to pooling of blood in lower extremities –> all leads to dizziness and loss of consciousness = fall

35
Q

What are the types of syncope?

A
  • neurally mediated
  • orthostatic hypotension
  • cardiac
  • drug-induced
  • multifactorial
  • unexplained
  • cerebral vascular disease
  • psychogenic
36
Q

What are common causes of neurally mediated syncope?

A

-vasovagal; situational
- defecation, urination, coughing, eating;
MC-carotid sinus syncopes

37
Q

What are common causes of orthostatic hypotension?

A
  • autonomic failure from underlying disease
  • Parkinson’s, spinal cord injury
  • drug-induced
  • EtOH, vasodilators, diuretics, phenothiazines, antidepressants
  • volume depletion
38
Q

What are common causes of cardiac syncope?

A

-arrhythmias (bradycardia, tachycardia)
-structural heart disease
- valvular disease, acute infarction, hypertrophic cardiomyopathy,
cardiac mass, tamponade
*CP or dyspnea strong clue

39
Q

What are common causes of drug-induced syncope?

A

-EtOH, vasodilators, diuretics, phenothiazines, antiarrhythmics, QT-prolonging drugs

40
Q

What are common causes of cerebral vascular disease syncope?

A

-stroke -TIA -seizure

41
Q

What are the two biggest body systems causing syncope that we worry about?

A

cardiac & nervous system!

42
Q

How can you use carotid sinus massage to help determine what is causing syncope?

A

Nothing happens - negative carotid sinus massage test If BP drops or HR slows and pt gets dizzy/faint - positive carotid massage test
*can indicate neurally mediated syncope

43
Q

What are criteria that suggest cardiac etiology of syncope that should prompt hospitalization?

A

-syncope while supine
-syncope during exertion
-palpitations prior to syncope
-family hx of sudden cardiac death -
hx of previous MI -low EF -signs of HF -abnormal EKG -systolic BP <90mmHg

44
Q

What questions should you ask when a pt presents after a fall c/o dizziness?

A
  • was the onset sudden?
  • is the dizziness constant or periodic? -how long do the episodes last? -how is the dizziness impacting the patient’s life?
45
Q

What common causes of dizziness can often cause falls?

A
  • postural hypotensin
  • benign positional vertigo
  • anxiety
  • depression
  • cardiac arrhythmia
46
Q

What body system classically causes dizziness prior to a fall?

A

cardiac! start here

47
Q

What type of dizziness would one describe with vertigo?

A

spinning, sense of rotation

48
Q

What might be on your differential if the dizziness is episodic?

A

recurrent vestibulopathy, BPPV, TIA, Meniere’s disease

49
Q

What might be on your differential if the dizziness if continuous?

A

meds, psychological

50
Q

How should you treat dizziness in old age?

A
  • identify primary diagnosis and use a specific therapeutic agent,
  • provide symptomatic relief
  • identify contributing sensory deficits and manage them
  • exercise can treat BPPV, reduce balance problems, lower risk of falls
  • if at risk of falls, consider walking aid and home assessment
51
Q

How can we ask providers decrease the risk of falls?

A
  • obtain hx of falls
  • perform a fall-risk assessment
  • initiate an intervention
52
Q

What is encompassed within a fall-risk assessment?

A

-gait examination:
asymmetric weight distribution
5 meters adequate to assess slow (0.6 meter/second) predicts hospitalization and functional decline

53
Q

What is the Timed Get Up and Go test?

A

Time necessary to: -stand up from a chair with arms -walk 3m (10ft) -turn -walk back to the chair -sit down Most adults can complete in 10sec
Frail elders can complete in 11-20 seconds
>14s = increased fall risk
>20s = comprehensive eval indicated

54
Q

What factors can be modified to help decrease fall risk?

A
  • meds (psychotropics)
  • muscle weakness
  • hypotension
  • remove restraints
55
Q

What are some nonmodifiable factors that increase risk of falls?

A

-hemiplegia -blindness

56
Q

What Intrinsic fall interventions can be implemented to help decrease risk for falls?

A

-treat underlying disease
-eliminate drugs and dosages
-initiate PT
initiate exercise

57
Q

What Extrinsic fall interventions can be implemented to help decrease risk for falls?

A
  • reduce environmental hazards
  • reduce/remove restraints
  • improve fall surveillance
  • consider protective pads and floors and/or a low bed
58
Q

What three areas does general rehabilitation cover?

A
  • normal aging, disuse and deconditioning (strength, balance, coordination)
  • cardiovascular problems like vascular disease and stroke -skeletal problems: osteoporosis and osteoarthritis, knee and hip replacements
59
Q

What are the goals for pts when they are engaged in rehab therapy?

A
  • complete recovery with full, unrestricted function

- recovery ADLs

60
Q

What do the results of rehab depends on?

A

MOTIVATION

61
Q

What is rehab like at an acute care hospital?

A

most extensive and intensive care pts w/ good potential for recovery and can participate in and tolerate aggressive therapy >3h/d

62
Q

What is rehab like at a SNF?

A

less intensive programs 1-3h/d, up to 5d/wk

pts less able to tolerate therapy

63
Q

What is rehab like with home health?

A

less varies and less frequent rehab 3x/wk

*this is generally not enough

64
Q

What is important to include when writing the referral for therapy?

A

-referral should state the diagnosis and goal of therapy -specific as possible

65
Q

What is occupational therapy? What do they generally work with?

A

-self-care activities and improvement of fine motor coordination of muscles and joints, particularly in the upper extremities -ADLs –> the cornerstones of independent living

66
Q

What is physical therapy? What are their goals and what do they work on?

A
  • improve joint and muscle function and thus improve pts ability to stand, balance, walk, climb stairs,
  • usually used to train lower-extremities, gross motor skills, ROM; strength and conditioning; coordination exercises; proprioceptive neuromuscular function; ambulation exercises; transfer training
67
Q

What disorders can speech therapists help with?

A
  • expressive aphasia: letter or picture board
  • dysarthria or apraxia: breathing and muscle control plus repetition exercises, electronic device w/ keyboard and message display
  • postlaryngectomy: new way to produce a voice
  • diagnosis and treatment of swallowing d/o
  • cognition!
68
Q

What therapeutics and assistive devices are available for pts?

A

-orthoses -walking aids -wheelchairs -mobility scooters -protheses

SUMGERI (14 decks)

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