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Ageing > Immobility and Falls > Flashcards

Immobility and Falls Flashcards

1
Q

What is the trend with disability and age

A

As we age, more people have a disability

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2
Q

What is the most common type of disability

A

Mobility issue

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3
Q

What are some of the traumatic causes of immobility

A

Brain/spinal cord injury
Multiple trauma
Fractures
Falls

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4
Q

Which illnesses can lead to immobility

A 
Stroke 
Heart failure 
MI 
Cancer 
Infections
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5
Q

Which long term conditions can lead to immobility

A 
COPD 
Diabetes 
Arthritis 
Parkinson's 
MS
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6
Q

Physical inactivity contributes to disability - true or false

A

TRUE

4th biggest cause

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7
Q

What are the guidelines for exercise in the UK

A

150 mins of moderate exercise per week

Muscle strengthening on 2 days a week

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8
Q

What are some of the consequences of immobility

A 
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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9
Q

What does sarcopenia increase your risk of

A

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

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10
Q

Describe the trend in muscle mass

A

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

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11
Q

What is sarcopenia

A

Loss of muscle mass and function

Can be age related

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12
Q

What is osteopenia

A

Age related loss of bone mass

Exacerbated by immobility

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13
Q

How can we prevent the consequences of immobility

A

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

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14
Q

What are the key principles of rehabilitation

A

Patient centred
Setting smart but clear goals
Coordinated with other professionals

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15
Q

What are the SMART goals

A 
Specific - to patient 
Measurable 
Achievable 
Realistic 
Timely - regular on a shorter scale
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16
Q

What are the major consequences of falls

A

Pain and injury
Distress
Loss of confidence and independence
Increased mortality

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17
Q

Which groups are at risk of falls

A 
The elderly - 1/2 of all 80+ y/o fall each year  
Women more commonly 
Care-home residents 
Hospitalised patients 
Cognitively impaired
18
Q

Which physiological ‘symptoms’ of ageing increase risk of falls

A

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

19
Q

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

A

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

20
Q

Significant facial injury after a fall is suggestive of what

A

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

21
Q

What are common causes of the syncope that leads to falls

A 
Arrythmias
Orthostatic hypotension
Neurogenic (vasovagal)
Carotid sinus hypersensitivity
Valvular heart disease (Aortic stenosis)
22
Q

What defines orthostatic hypotension

A

Fall in SBP >20 mmHg or

Fall in DBP >10 mmHg after 3 minutes of standing

23
Q

Which neurological conditions can lead to falls

A 
Cervical myelopathy 
Cerebellar ataxia 
Peripheral neuropathy 
Lumbar stenosis 
Parkinson's 
Strokes 
Dementia
24
Q

What is cervical myelopathy

A

cord impingement due to arthritis etc.

Causes a high-stepping gait

25
Q

What are the extrinsic risk factors for falls

A 
Certain medication - polypharmacy especially 
Alcohol 
Environmental hazards - trips or stairs 
Inappropriate clothing or footwear 
Inappropriate walking aids 
Bad weather
26
Q

Which common drugs increase fall risk

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

And MANY more

27
Q

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

A

TRUE

being on 4 or more drugs increases risk

28
Q

How do you properly record a lying and standing BP

A

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

29
Q

What is the timed up and go test

A

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

30
Q

How can we prevent further falls

A

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

31
Q

How should medication be altered after a fall

A 
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
32
Q

What should be included in a falls history

A 
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
33
Q

How does frailty present

A

Instability and falls
Immobility
Intellectual impairment
Incontinence

34
Q

What is involved in a comprehensive geriatric assessment

A

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

35
Q

What is the definition of osteoporosis

A

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

36
Q

Describe the underlying process of osteoporosis

A

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

37
Q

What can cause osteoporosis

A

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

38
Q

How does osteoporosis present

A

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

39
Q

How do you diagnose osteoporosis

A

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

40
Q

How do you treat osteoporosis

A

1st line is oral bisphosphonate - alendronate or risendronate

2nd line - IV bisphosphonate and desosumab (monoclonal which inhibits osteoclasts)

41
Q

What is the major risk with bisphosphonate treatment

A

Osteonecrosis of the jaw

Ageing (7 decks)

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