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
