Immobility and falls Flashcards

1
Q

what are the outcomes of a fall?

A
injury - soft tissue, fracture, subdural 
rhabdomyolysis  
delirium 
loss of confidence/ 'fear of falling'
stress on carer 
dependancy 
terminal decline 
institutionalisation
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2
Q

what is rnhabdomylosis?

A

breakdown/death of the muscle which causes it to release its contents into the bloodstream which can cause renal failure

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3
Q

what are the common causes of rhabdymyolysis?

A

injury
medications - colchicine, statins, cyclosporin, erythromycin, cocaine, amphetamines
over exertion
infection

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4
Q

what are the risk factors for falls in the elderly?

A
balance deficit
gait deficit
visual deficit 
muscle weakness 
history of falls 
arthritis
> 80 yrs
cognitive impairment 
depression
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5
Q

what is the main cause of immobility in the elderly?

A

sarcopenia

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6
Q

what is sarcopenia and what causes it?

A

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
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7
Q

what are the complications of immobility?

A
loss of muscle mass 
loss of strength
constipation
incontinence 
hypostatic pneumonia 
hypothermia 
pressure sores 
DVT 
osteoporosis
isolation
institutionalisation
depression/ anxiety 
loss of confidence
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8
Q

what are the different causes of falls?

A

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
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9
Q

an elderly patient falls out of their bed on the ward.

what are your main concerns and what initial assessments would you carry out?

A

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

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10
Q

what is involved in the multi-disciplinary treatment of a patient who presented with a fall?

A
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)
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11
Q

how do you assess someones risk of osteoporosis?

A

assess risk with FRAX score or Q fracture tool

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12
Q

when would you refer someone for a bone scan ?

A

if their FRAX score is 10% in 10yrs

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13
Q

what is the cut-off scores for osteopenia and osteoporosis?

A

osteopenia - T score between -1 and -2.5

osteoporosis - T score < -2.5

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14
Q

what are the treatment options for osteoporosis?

A

first line: vitamin D and Ca supplements
second line: bisphosphonates (oral/IV)
third line: prophylactic fixation

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15
Q

what are the most common sites of fracture in patients with osteoporosis?

A

hip > wrist > vertebrae

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16
Q

what is involved in the multidisciplinary assessment of a patient who presents with an unexplained fall?

A
visual impairment 
falls history 
osteoporosis risk
medications
cognitive impairment 

urinary incontinence

balance disturbance
gait disturbance
mobility and functional impairment

home hazard
functional ability

17
Q

what occupations are involved in the assessment and management of an elderly patient who presents with a fall?

A
geriatrician 
medical doctors 
nurses 
occupational therapist
physiotherapist
18
Q

what medications increase risk of falls in the elderly?

A
anti-cholinergic i.e. tricyclic antidepressants, incontinence medications (duloxetine) 
sedatives i.e. benzodiazepine 
antidepressants 
beta blockers
opioids
alcohol
19
Q

an elderly patient presents to the A and E with a fall.

what are your main concerns you need to check for?

A
rhabdomyolysis 
pneumonia 
serious for tissue/bony injury 
skin injury 
extradural haemorrhage
20
Q

an elderly patient presents to the A and E with a fall.

what initial investigations will you carry out?

A

FBC - CK, blood glucose, folate, B12, TSH
BP
ECG
head CT (if indicated by symptoms)