Geriatrics - FALLS!

Question 1

name some Intrinsic factors which lead to falls

Answer 1

gait/balance issues (postural intability, vertigo), syncope (cardiac, vagal), cronic disease (neuro, msk), visual issues, acute illness, cognitive disorder, vitD deficiency.

Question 2

Name some Extrinsic factors which lead to falls

Answer 2

innapropriate footwear, environmental hazards, poor lighting.

Question 3

Name some Situational factors which lead to falls

Answer 3

medications (antidep, antipsyc, anticholinergics, benzodiazepines, anti-yhpertensives, diuretics), alcool, urgency of micturition.

Question 4

how is postural stability achieved?

Answer 4

cerebral perfusion (cardiac putput and vasomotor tone). Visual input to cenntral processing resulting in muscular activity.

Question 5

How would you assess gait and balannce?

Answer 5

sitting to standing ability / static balance standing / Romberg test, dynamic standing balance / gait / tinetti gait / berg balance scale.

Question 6

what may cause vertigo?

Answer 6

labyrinthitis, acute ear infection, bennign paroxysmal positional vertigo, menieres, cereberebellar pathology.

Question 7

causes of syncope

Answer 7

neurally mediated (vasovagal, carotid sinus hyoersensitivity, situationnal syncope) orthostatic hypotension (autonomic failure, volume depletion.), Cardiac arrhythmias (sinus node dysfunction, av connduction disease), Structural cardiac disease (valvular, cardiomyopathy, aortic dissection), Cerebrovascular (subclavian steal syndrome)

Question 8

management, Hx and Ix of syncope

Answer 8

hx from patient, fhx, medications, pmh, collateral hx (circumstances, appearance, jerking, tounge biting, weakness down one side), examination (bp, neuro, cardio, injuries), 12 lead ecg (innapropriate, persistent bradycardia, long qt, abnormal t wave inversion)

Question 9

what are red flags when assessing syncope according to NICE?

Answer 9

ecg abnormaility, HF, onset with exersion, fhx, breathlessness, heart murmur.

Question 10

assume a syncope is a seizure if one or more of thhe following…

Answer 10

bitten tounge, head turning to one side, no memory, prolongued and simultaneous limb jerking, confusion after te event, prodromal déjà vu.

Question 11

what acute illnesses may lead to falls?

Answer 11

limited cerebral function, hhypoxia, infectionns (chest, UTI), dehydration. Often assosiated with Delerium.

Question 12

what cognitive disorders may lead to falls?

Answer 12

Dementia (impaired judgement, abnormal gait, effects perception), delerium, depression/ anxiety.

Question 13

how is the risk of osteoporosis assessed?

Answer 13

FRAX or QFRACTURE tool. Asses BMD via DEXA scanning-1–> -2.5 = osteopenia. Socre of less than -2.5 = osteoporosis.

Question 14

what are the most common sites of fracture?

Answer 14

hip, wrist, vertebrae.

Question 15

how is osteoporosis tx

Answer 15

biposphonates (oral/iv), teriparatide, denosumab. Also vitD and calcium supplements.

Question 16

what is Sarcopenia

Answer 16

syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength and it is strictly correlated with physical disability, poor quality of life and death

Question 17

what leads to/ precipitates Sarcopenia?

Answer 17

DM, 
elderly, 
chronic disease, 
lack of use, 
inflammation, 
nutritional deficiency, 
endocrine dysfunction.

Question 18

name some complications of immobility…

Answer 18

muscle wasting, 
contractures, 
pressure sores, 
dvt, 
constipaiton, 
incontinence, 
hypothermia, 
hypostatic pneumonia, 
osteoporosis.
Depression, 
isolation.

Question 19

Case 1 …

Answer 19

87w, fallen over at home - states she just tripped and never usually falls. Complains of left ankle pain but has mobilised since falling. Social History: Lives alone. No care. Independent with all ADLs. Walks with a stick. Medication (from ECS): Amlodipine 10mgSimvastatin 40mg, Ramipril 5mg, Aspirin 75mg. Take a collateral hx, tests, stop some drugs, mdt assessment.

Question 20

Case 2 …

Answer 20

75w, Normally very fit and well, Found by daughter on bathroom floor, Very confused and disorientated. Recent frequency of micturition – commenced on trimethoprim by GP, Social History: Lives alone – no carers. Uses no walking aid. Medication: Amitriptyline 20mg nocte, Trimethoprim 200mg BD. Check for any external injuries, assess cognition, collateral hx, tests, mdt assessment.

Question 21

Case 3 …

Answer 21

90m, Recurrent admissions with falls – known to have significant postural hypotension, Significant peripheral oedema and hypoalbuminaemia – cause not identified. Admitted with diarrhoeal illness with worsening of dizziness. Social History: Lives with partner in 6th floor flat – has been unable to climb stairs for over a year. Mobile with zimmer frame Care once daily for personal care. Medication: Spironolactone 50mg, Midodrine 5mg BD. found to be dehydrated mildly, dvt on right leg. bp falls when standing up. withhold spironolactone, uss doppler confirms dvt in common femoral vein. start rivaroxaban cautiously. assess gait and balance, tests, review medications