Geriatric Falls Assessment Flashcards
T/F: Falls are the most common cause of nonfatal injuries and hospital admissions for trauma
TRUE
Falls and the Elderly, stats
- 1/5 of falls cause serious injury (fracture, head injury)
- 20-30% of people who suffer moderate to severe injuries such as lacerations, hip fractures, or head trauma
- most fractures among older adults are caused by falls
- many people who fall, even if they are not injured, develop a fear of falling
T/F: falls are a normal part of getting older
FALSE
they are preventable
how would you define a fall?
an unintentional loss of balance that leads to failure of postural stability
what constitutes a recurrent faller?
2 or more falls in 6-12 months
Best Practices for managing at risk-fallers (older adults)
- ask about falls within past 12 months
- assess strength, balance, and gait
- assess for need of AD prescription
- provide supervised, structured exercise program
Best practices for managing those who have had 2+ falls in past year
- basic fall history
- assess for OH
- assess visual acuity
- assess strength, balance, and gait
- home assessment for fall hazards
- review medications
- assess appropriateness of AD
- assess cognitive status
Questions to ask about falling
- have you fallen?
- can you tell me what caused you to fall?
- did someone see you fall? if yes, did you have a LOC?
- did you go see your doctor or to the ED?
- did you get hurt?
- which direction did you fall?
- did you recently change any of your medications
what to consider when examining vision relating to postural control
- acuity
- contrast sensitivity
- depth perception
- visual field cut
what to consider when examining vestibular relating to postural control
- VOR function and gaze stability
- nystagmus
- saccades
- smooth pursuit
- head impulse test
- head shake test
- dynamic visual acuity test
- skew deviation test
- VOR cancellation
what to consider when examining the somatosensory system pertaining to postural control
- cutaneous sensation
- proprioception
- vibration
what test can be performed to look at sensory integration?
CTSIB
(Clinical Test of Sensory Interaction and Balance)
List the 6 conditions in the CTSIB?
- eyes open on firm surface
- eyes closed on firm surface
- eyes open with sway referenced visual surround
- eyes open on sway referenced support surface
- eyes closed on sway referenced support surface
- eyes open on sway referenced support surface and surround
falls in which conditions of the CTSIB indicate vestibular dysfunction?
conditions 5 and 6
falls during which CTSIB conditions indicate surface dependence?
conditions 4, 5, 6
list several balance strategies
- ankle strategy
- hip strategy
- stepping strategy
- reaching strategy
- suspensory strategy
describe a suspensory balance strategy
lowers COG to enhance postural stability
flexing knees, lowering COG
a strength, ROM, and endurance program should be at least _______ in duration
10 weeks
how does a home evaluation play into falls prevention?
it is a key preventative method to prevent falls
allows the following:
- exploration of potential risk factors
- ID changes are necessary
- ID sources of payment and other potential resources
- locate quality supplies and qualified installers
what are the 3 parts of a home eval?
- assess commonly used areas inside and outside the home
- observe the person moving around the environment
- determine the person’s fall risk and health status
how does functional performance testing inform our clinical practice relating to older adults?
- objective, accurate record
- measures what is pertinent to the patient
- informs impairments
- informs goal setting
- comparison of age-based normative data
- prognostic
list some limitations of MMT in older adults
- ceiling effect of available strength
- make test → inaccuracies of available test
- break test → can be aggressive in frail pts
- subjective grading
- pt effort, understanding, willingness affects results
- testing position may not reflect functional performance (open-chain testing vs closed-chain function)
list types of functional outcome measures
- self-report → pt perception of impairment, function, QOL
- patient outcome measure → ask pts about impact of condition on activities and roles in life
- observer-rated measures → measures observed by PT
- physiological measures → measure single biological entity (ie cognitive ability, pain, exertion)
what is the difference between specificity and sensitivity?
specificity → good for ruling in
sensitivity → good for ruling out
what is the difference between +/- LR?
- +LR → likelihood that a + test is accurate
- -LR → likelihood that a - test is accurate
list several walking tests that can be used in geriatrics
- 2 MWT, 6 MWT
- Gait speed
- DGI
- FGA
- TUG
- Figure 8 Walking test
list several mobility scales that can be used in geriatrics
- 30-second CRT (chair rise test)
- 5x and 10x STS
- Floor transfer
list several balance tests that can be used in geriatrics
- BESTest, BESTmini, BESTbrief
- Berg Balance Scale
- Activities Specific Balance Confidence (ABC) scale
- Functional reach test
- 4 square step test
- Tinetti performance-oriented mobility assessment (POMA)
- Single leg stance
list several outcome measures that assess physical performance
- physical performance test
- physiological profile assessment (PPA)
- short physical performance battery (SPPB)
- grip strength
list several multidiscipline fall risk tools
- Morse Fall Scale
- Hendrich II Fall Risk Model (acute care setting only)
