Immobility and Falls Flashcards by Eilidh Selfridge

What is the trend with disability and age

As we age, more people have a disability

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What is the most common type of disability

Mobility issue

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What are some of the traumatic causes of immobility

Brain/spinal cord injury
Multiple trauma
Fractures
Falls

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Which illnesses can lead to immobility

Stroke 
Heart failure 
MI 
Cancer 
Infections

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Which long term conditions can lead to immobility

COPD 
Diabetes 
Arthritis 
Parkinson's 
MS

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Physical inactivity contributes to disability - true or false

TRUE

4th biggest cause

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What are the guidelines for exercise in the UK

150 mins of moderate exercise per week

Muscle strengthening on 2 days a week

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What are some of the consequences of immobility

Sarcopenia 
Osteopenia 
Decreased blood volume 
Cardiac deconditioning 
Postural hypotension 
DVT 
Increased risk of pneumonia and other infections 
Risk of contractures 
Pressure sores 
Kidney stones and UTI's
Constipation

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What does sarcopenia increase your risk of

Cardiometabolic disorders such as insulin resistance, metabolic syndromes and CV disease
Falls and fractures

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Describe the trend in muscle mass

Starts to decline at around 30 y/o
This accelerates after 60
Made worse with immobility

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What is sarcopenia

Loss of muscle mass and function

Can be age related

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What is osteopenia

Age related loss of bone mass

Exacerbated by immobility

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How can we prevent the consequences of immobility

Resistance exercises 2xper week
Aerobic exercise - 150 mins
Encourage patients to get mobile and dress themselves (within reason)

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What are the key principles of rehabilitation

Patient centred
Setting smart but clear goals
Coordinated with other professionals

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What are the SMART goals

Specific - to patient 
Measurable 
Achievable 
Realistic 
Timely - regular on a shorter scale

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What are the major consequences of falls

Pain and injury
Distress
Loss of confidence and independence
Increased mortality

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Which groups are at risk of falls

The elderly - 1/2 of all 80+ y/o fall each year  
Women more commonly 
Care-home residents 
Hospitalised patients 
Cognitively impaired

Which physiological ‘symptoms’ of ageing increase risk of falls

Slower reaction times
Decrease in vision - smaller pupils and lens thickening
Decreased cardiorespiratory fitness
Sarcopenia
Decreased peripheral sensation and proprioception
Postural instability due to loss of muscle mass or reduced autonomic reactivity
Bladder issues - often fall trying to rush to toilet
Overall deconditioning

Multiple chronic conditions increase your risk of falls - true or false

TRUE
Many systems and diseases can contribute to fall risk
Sometimes an acute problem is the cause

Significant facial injury after a fall is suggestive of what

Syncope
Haven’t put hands out to break fall
Common cause

What are common causes of the syncope that leads to falls

Arrythmias
Orthostatic hypotension
Neurogenic (vasovagal)
Carotid sinus hypersensitivity
Valvular heart disease (Aortic stenosis)

What defines orthostatic hypotension

Fall in SBP >20 mmHg or

Fall in DBP >10 mmHg after 3 minutes of standing

Which neurological conditions can lead to falls

Cervical myelopathy 
Cerebellar ataxia 
Peripheral neuropathy 
Lumbar stenosis 
Parkinson's 
Strokes 
Dementia

What is cervical myelopathy

cord impingement due to arthritis etc.

Causes a high-stepping gait

What are the extrinsic risk factors for falls

``` Certain medication - polypharmacy especially Alcohol Environmental hazards - trips or stairs Inappropriate clothing or footwear Inappropriate walking aids Bad weather ```

Which common drugs increase fall risk

``` Benzodiazepines Neuroleptics Antihypertensives - especially if over used Antidepressants Anticholinergics Class 1A antiarrthymics Opiates B-blockers - reduce tachycardia response ``` And MANY more

Polypharmacy is an independent risk factor for falls - true or false

TRUE | being on 4 or more drugs increases risk

How do you properly record a lying and standing BP

1st BP: taken after lying for at least five minutes. 2nd BP: taken after standing in the first minute 3rd BP: taken after standing for three minutes Record any symptoms

What is the timed up and go test

Time how long it takes them to stand, walk three meters, turn and sit back down If they use mobility aids, they are allowed to use them If time is greater than 12 seconds then it is considered slow

How can we prevent further falls

Strength and balance training - physio Environmental modifications - OT home assessment Improve footwear and foot care - podiatry Vision optimisation Patient education and treatment Medication review

How should medication be altered after a fall

``` Assess if any medication can be stopped if on more than 4 Stop any psychoactive meds Consider added calcium/vit D Manage postural hypotension Cardiac pacing if needed ```

What should be included in a falls history

``` Number of falls in past year Detail of most recent fall Ask about first or most dramatic Any warning symptoms, LOC, injuries etc Length of lie, how did they get up How is it affecting day to day life Mobility ```

How does frailty present

Instability and falls Immobility Intellectual impairment Incontinence

What is involved in a comprehensive geriatric assessment

It is a thorough and holistic approach to frailty | Includes physical and mental heath, level of function, social support, living environment and a medication review

What is the definition of osteoporosis

A loss of bone density resulting in thin bones but with normal mineralisation

Describe the underlying process of osteoporosis

There is an imbalance in the production and resorption of bone resulting in an overall loss

What can cause osteoporosis

Failure to achieve maximal bone mass by age 35 Endocrine dysfunction - hypogonadism, hyperthyroidism, hyperparathyroidism, Cushing's Malabsorption - coealic, IBD, poor calcium intake Inactivity/Immobility - seen in elderly Drugs - steroids Smoking and alcohol Family history

How does osteoporosis present

Fragility fractures - vertebral bodies, NoF, radius/ulna, pelvis, falls from standing height Loss of height Dowager's hump Kyphoscoliosis

How do you diagnose osteoporosis

Do routine bloods plus TSH, myeloma screen, coeliac screen to check for other causes Do a DXA scan

How do you treat osteoporosis

1st line is oral bisphosphonate - alendronate or risendronate 2nd line - IV bisphosphonate and desosumab (monoclonal which inhibits osteoclasts)

What is the major risk with bisphosphonate treatment

Osteonecrosis of the jaw