Immobility and Falls Flashcards
Define a fall
inadvertently coming to rest on the ground or other lower level without loss of consciousness and other than as a consequence of sudden onset of paralysis, epileptic seizure, excess alcohol intake or overwhelming physical force
incidence of falls
30% > 65 community
40% > 80 community
50% of those in hospital/care facilities
consequences of falling
death
hip fracture - 25% die, 75% never get back to their pre-fall health
outcomes after a fall
injury - soft tissue, fracture, subdural rhabdomyolysis loss of confidence/fear of falling inability to cope dependency/decreased QoL carer stress institutionalisation terminal decline
risk factors for falling
muscle weakness Hx gait deficit use of assistive device visual deficit arthritis impaired ADK depression cognitive impairment >80 years
intrinsic factors of falling
gait and balance problems: postural instability vertigo chronic disease visual problems acute illness cognitive disorder vitamin D deficiency
situational factors causing falls
medications
alcohol
urgency of micturition
extrinsic factors of falling
inappropriate footwear
environmental hazards - uneven paving, carpets, walking aids, stairs
poor lighting
unfamiliar environment
what factors are necessary for balance?
appropriate HR and BP
cerebral perfusion - CO, vasomotor tone
how can you assess gait and balance?
sitting to standing ability static standing balance Romberg test Dynamic standing balance - funcitonal reach, tandem walking, timed walked gait tinetti gait and balance scale Berg balance scale timed get up and go test
vasovagal syncope
common faint
inappropriate stimulation of vagus nerve
sweating, nausea, tunnel vision
carotid sinus hypersensitivity syncope
exaggerated response to carotid baroreceptor stimulation
situational syncope causes
acute haemorrhage cough, sneeze GI stimulation - swallow, defaecation, visceral pain Micturition (post) Post exercise Brass instrument weightlifting
orthostatic hypotension syncope
autonomic failure
primary autonomic failure sydrome
secondary autonomic failure syndrome
drug
volume depletion
groups of causes of syncope
neural mediated reflex syncope orthostatic hypotension syncope cardiac arrhythmia syncope structural cardiac or cardiopulmonary disease syncope cerebrovascular syncope
what types of syncope fall within neural mediated reflex syncope?
vasovagal
carotid
situational
cardiac arrhythmia syncope causes
sinus node dysfunction
AV conduction system disease
paroxysmal supraventricular and VTs
inherited syndromes e.g. long QT syndrome, Brugada syndrome
Implanted device malfunction e.g. pacemaker, ICD
drug induced
structural cardiac or cardiopulmonary disease syncope causes
cardiac valvular disease acute MI obstructive cardiomyopathy atrial myxoma acute aortic dissection pericardial disease/tampoade PE
cerebrovascular syncope causes
subclavian steal syndrome
when would you consider seizure rather than syncope?
>=1 of: bitten tongue head turning to one side no memory of abnormal behaviour that was witnessed before, during or after unusual posturing prolonged, simultaneous limb-jerking confusion after
when would you consider syncope rather than seizure?
prodromal symptoms that on other occasions have been abolished by sitting or lying
sweating prior
precipitated by prolonged standing
pallor
what medications may cause falls?
TCAs (also increased risk of osteoporosis) Antipsychotics Anticholinergics Antimuscarinics Benzodiazepines Diuretics
what tools can you use to assess risk of osteoporisis?
FRAX or QFRACTURE
A T score of -1 - -2.5 suggests?
Osteopenia
What are the most common sites of fracture in osteoporosis?
Hip, writ, vertebrae
Medications for osteoporosis
Vit D + calcium
Bisphosphonates - teriparatide, denosumab
Treatment of falls
Cause Strength and balance training home hazard and safety intervention medication review cardiac pacing
complications of immobility physical
muscle wasting muscle contractures pressure sores DVT constipation/incontinence hypothermia hypostatic pneumonia osteoporosis
complications of immobility psychological
depression
loss of confidence
complications of immobility social
isolation
institutionalisation
