Immobility and Falls Flashcards
What is the trend with disability and age
As we age, more people have a disability
What is the most common type of disability
Mobility issue
What are some of the traumatic causes of immobility
Brain/spinal cord injury
Multiple trauma
Fractures
Falls
Which illnesses can lead to immobility
Stroke Heart failure MI Cancer Infections
Which long term conditions can lead to immobility
COPD Diabetes Arthritis Parkinson's MS
Physical inactivity contributes to disability - true or false
TRUE
4th biggest cause
What are the guidelines for exercise in the UK
150 mins of moderate exercise per week
Muscle strengthening on 2 days a week
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
What does sarcopenia increase your risk of
Cardiometabolic disorders such as insulin resistance, metabolic syndromes and CV disease
Falls and fractures
Describe the trend in muscle mass
Starts to decline at around 30 y/o
This accelerates after 60
Made worse with immobility
What is sarcopenia
Loss of muscle mass and function
Can be age related
What is osteopenia
Age related loss of bone mass
Exacerbated by immobility
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)
What are the key principles of rehabilitation
Patient centred
Setting smart but clear goals
Coordinated with other professionals
What are the SMART goals
Specific - to patient Measurable Achievable Realistic Timely - regular on a shorter scale
What are the major consequences of falls
Pain and injury
Distress
Loss of confidence and independence
Increased mortality
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
