Immobility and Falls Flashcards
Define a fall
- Inadvertently coming to rest on the ground
- Without LOC
- Not caused by seizures, being drunk, overwhelming physical force, sudden onset of paralysis
Outcomes of a fall
- Injury (soft tissue, fracture, SA haemorrhage)
- Rhabdomyolysis (increased CK)
- Loss of confidence/independence/reduced QOL
Risk factors for falls
- Muscle weakness
- Gait/balance/visual deficit
- Cognitive impairment
- Age
3 types of factors contributing to falls
- Intrinsic factors
- Extrinsic factors
- Situational factors
7 intrinsic factors
- Gait + balance problems
- Syncope
- Chronic disease (neuro/msk)
- Acute illness
- Cognitive disorder
- Vitamin D deficiency
- Visual problems
3 extrinsic factors
- Inappropriate footwear
- Environmental hazards (uneven paving, stairs)
- Poor lighting
3 situational factors
- Alcohol
- Urgency of micturition
- Medications
Medications that increases risk of fall
- Antidepressants
- Antipsychotics
- Anticholinergics
- Antihypertensives
- Benzodiazepines
- Diuretics
What kind of antidepressant carries the higher risk of fall
TCAs > SSRIs
3 parts of controlling balance
- Sensory input (visual, vestibular, proprioceptive)
- Central processing (cerebrum, cerebellum, basal ganglia, brain stem)
- Muscular activity
What is assessed in a gait + balance assessment
- Sitting to standing ability
- Transfers
- Static standing test
- Romberg test
- Heel-toe walking
- Gait
2 scales used to test balance + gait
- Tinettie gait + balance scale
- Berg balance scale
5 causes of vertigo
- Labrynthitis
- Acute ear infection
- Meniere’s disease
- Cerebellar/brainstem pathology
- Benign paroxysmal positional vertigo
Management of transient LOC
- Hx (patient + collateral)
- Examination
- 12 lead ECG
- Assess for red flags + consider other tests
Hx for syncope (patient)
- Prodromal symptoms
- LOC ?
- Last and first thing they recall
- Previous episodes
- Injuries?
- PMHx + DHx + FHx (including sudden death)
Collateral Hx for syncope
- Circumstances of event
- Posture immediately before LOC
- Appearance
- Limb-jerking/Tongue-biting?
- Duration (onset to regaining consciousness)
- Confusion during recovery period? (postictal (5-30mins) )
- Unilateral weakness during recovery period
Examination of syncope
- Vital signs, including lying + standing BP
- Focussed neuro + cardio exam
- Look for any injuries
3 red flag ECG findings
- Inappropriate, persistent bradycardia
- Long QT and short QT intervals
- Abnormal T wave inversion
Red flags for syncope
- Onset with exertion
- FHx of sudden cardiac death (<40yrs)
- New unexplained breathlessness
- Murmur (?new?)
7 reasons to suspect a seizure
- Bitten tongue
- Head turning to 1 side during episode
- No memory of abnormal behaviour that was witnessed before, during or after event
- PRONLONGED, simultaneously limb-jerking
- Confusion after event (postictal)
- Prodromal deja vu or jamais vu
- Unusual posturing
4 reasons to NOT suspect a seizure
- Prodromal symptoms that on other occasions have been abolished by sitting or lying down
- Sweating before the episode
- Precipitated by long standing
- Pallor during the episode
Describe “off legs”
- Hypoxia therefore impaired central processing of info, or correction of imbalance
- Usually secondary to acute illness (infection/dehydration)
- Usually reversible
- Often associated with delirium
4 reasons dementia can lead to falls
- Impaired judgment
- Abnormal gait
- Affects visuospatial perception
- Affects ability to recognise + avoid hazards
(Also think medication e.g. anticholinesterase)
How to asses risk of osteoporosis
FRAX or QFRACTURE tool
How to assess BMD
DEXA scanning
What T-score suggests osteopenia and osteoporosis
-1 to -2.5 = Osteopenia
< -2.5 - = Osteoporosis
Most common site of fracture in elderly
- Hip
- Wrist
- Vertebrae
What is sarcopenia
The degenerative loss of skeletal muscle, quality, and strength associated with aging
Pneumonic for sarcopenia
DECLINE Diabetes/insulin resistance -Elderly -Chronic disease -Lack of us -Inflammation -Nutritional deficiency -Endocrine dysfunction
3 types of complications of immobility
- Social
- Psychological
- Physical (muscle wasting/contractures, pressure sores, DVT, hypostatic pneumonia)
