Immobility and falls Flashcards
what are the outcomes of a fall?
injury - soft tissue, fracture, subdural rhabdomyolysis delirium loss of confidence/ 'fear of falling' stress on carer dependancy terminal decline institutionalisation
what is rnhabdomylosis?
breakdown/death of the muscle which causes it to release its contents into the bloodstream which can cause renal failure
what are the common causes of rhabdymyolysis?
injury
medications - colchicine, statins, cyclosporin, erythromycin, cocaine, amphetamines
over exertion
infection
what are the risk factors for falls in the elderly?
balance deficit gait deficit visual deficit muscle weakness history of falls arthritis > 80 yrs cognitive impairment depression
what is the main cause of immobility in the elderly?
sarcopenia
what is sarcopenia and what causes it?
progressive loss of muscle mass an strength resulting in profound physical disability and poor quality of life
causes: Diabetes Elderly Chronic disease Lack of use Inflammation Nutritional deficiency Endocrine dysfunction
what are the complications of immobility?
loss of muscle mass loss of strength constipation incontinence hypostatic pneumonia hypothermia pressure sores DVT osteoporosis isolation institutionalisation depression/ anxiety loss of confidence
what are the different causes of falls?
intrinsic:
- syncope (cardiac, neurogenic)
- gait and balance (vertigo, postural instability)
- chronic disease
- visual problems
- acute illness (delirium)
- cognitive disorder
- vitamina D deficiency
extrinsic:
- shoe wear
- environmental hazard
- poor lightning
situational:
- alcohol /drugs
- urgency to micturate
- medications
an elderly patient falls out of their bed on the ward.
what are your main concerns and what initial assessments would you carry out?
fractured hip
- pelvic X-ray
subdural haematoma
- head CT if;
GCS < 13, nausea/vomiting, headache, confusion, loss of consciousness, seizure, basal skull fracture
blood glucose and BP
what is involved in the multi-disciplinary treatment of a patient who presented with a fall?
treat underlying cause if possible strength and balance training home hazard and safety intervention medication review /withdrawal cardiac pacing (in patients with cardio-inhibitory carotid sinus hypersensitivity and unexplained falls)
how do you assess someones risk of osteoporosis?
assess risk with FRAX score or Q fracture tool
when would you refer someone for a bone scan ?
if their FRAX score is 10% in 10yrs
what is the cut-off scores for osteopenia and osteoporosis?
osteopenia - T score between -1 and -2.5
osteoporosis - T score < -2.5
what are the treatment options for osteoporosis?
first line: vitamin D and Ca supplements
second line: bisphosphonates (oral/IV)
third line: prophylactic fixation
what are the most common sites of fracture in patients with osteoporosis?
hip > wrist > vertebrae
what is involved in the multidisciplinary assessment of a patient who presents with an unexplained fall?
visual impairment falls history osteoporosis risk medications cognitive impairment
urinary incontinence
balance disturbance
gait disturbance
mobility and functional impairment
home hazard
functional ability
what occupations are involved in the assessment and management of an elderly patient who presents with a fall?
geriatrician medical doctors nurses occupational therapist physiotherapist
what medications increase risk of falls in the elderly?
anti-cholinergic i.e. tricyclic antidepressants, incontinence medications (duloxetine) sedatives i.e. benzodiazepine antidepressants beta blockers opioids alcohol
an elderly patient presents to the A and E with a fall.
what are your main concerns you need to check for?
rhabdomyolysis pneumonia serious for tissue/bony injury skin injury extradural haemorrhage
an elderly patient presents to the A and E with a fall.
what initial investigations will you carry out?
FBC - CK, blood glucose, folate, B12, TSH
BP
ECG
head CT (if indicated by symptoms)
