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Specialities - Medicine of Old Age > Immobility & Falls > Flashcards

Immobility & Falls Flashcards

1
Q

What is the epidemiology of falls?

A

Annually:

  • 40% of those > 80 years old fall in community
  • 50% of those in hospital fall

Other:

  • 1 fall-related death every 5 hours in UK
  • 1% of falls result in hip fracture
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2
Q

In which age groups are falls the biggest problem?

A

80+’s

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3
Q

What are the most common outcomes after a fall?

A

1 - Injury: soft tissue, fracture, subdural etc.

2 - Rhabdomyolysis (release of muscle contents into blood following death of muscle fibres)

3 - Loss of confidence/ ‘fear of falling’

4 - Inability to cope

5 - Increased dependency

6 - Reduced QOL

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4
Q

What are the risk factors for falls?

A

1 - Muscle weakness

2 - History of falls

3 - Gait problems

4 - Balance problems

5 - Using a walking aid

6 - Visual deficit

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5
Q

Into what categories can the reasons for falls in the elderly be divided?

A

Intrinsic

Extrinsic

Situational

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6
Q

What are some of the intrinsic factors for elderly people falling?

A

1 - Gait and balance problems (postural instability or vertigo)

2 - Syncope (cardiac or vagal)

3 - Chronic disease (neurological or MSK)

4 - Visual problems

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7
Q

What are some of the situational factors that can cause the elderly to fall?

A

1 - Medications

2 - Alcohol

3 - Urgency of micturition

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8
Q

What are some of the extrinsic factors that can cause elderly people to fall?

A

1 - Inappropriate footwear

2 - Environmental hazards

3 - Poor lighting

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9
Q

What factors can affect gait and balance of an elderly person?

A

1 - Cerebral perfusion (reduced cardiac output or vasomotor tone)

2 - Posture & balance

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10
Q

What are the stages of controlling balance?

A

1) Sensory input (e.g. visual)
2) Central processing (e.g. cerebellum)
3) Muscular activity

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11
Q

How are gait and balance assessed in elderly patients?

A
  • Sitting to standing ability
  • Static standing balance
  • Rombergs test (patients stand and closes their eyes - reduced balance = +ve rombergs test)
  • Heel-toe walking
  • Gait
  • ‘Get up and go’ test
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12
Q

Which medical conditions could cause dizziness in an elderly patient?

A

1) Labrynthitis
2) Acute ear infection
3) Benign paroxysmal positional vertigo
4) Meniere’s
5) Cerebellar/brainstem pathology

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13
Q

What are the broad categories of causes of syncope?

A

1 - Neurally-mediated

2 - Orthostatic hypotension

3 - Cardiac arrythmias

4 - Structural cardiac

5 - Cerebrovascular

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14
Q

What are some of the neurally-mediated causes of syncope?

A

1 - Vasovagal syncope (common faint)

2 - Carotid sinus hypersensitivity

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15
Q

What are some of the causes of orthostatic hypotension?

A

1 - Autonomic failure

2 - Volume depletion (haemorrhage, diarrhoea)

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16
Q

What are some of the causes of syncope under cardiac arrythmias?

A
  • Sinus node dysnfunction
  • AV conduction disease
17
Q

What are some of the causes of syncope under structural cardiac diseases?

A
  • Aortic stenosis
  • Acute MI
  • Obstructive cardiomyopathy (thickening of the heart muscle)
  • Acute aortic dissection
  • Pericardial tamponade
18
Q

What is subclvian steal syndrome

A

Subclavian steal syndrome:

  • Subclavian artery becomes narrowed
  • Blood to the brain bypasses the subclavian artery and instead travels through the right and left vertebral arteries
  • The blood from the brain must then supply the upper limb (due to the blockage), so is considered as ‘stolen’ blood
19
Q

How are patients with a transient loss of consciousness (blackouts) managed?

A

1 - History from patient

2 - Collateral history (history from a relative, friend or observer)

3 - Examination

4 - 12 lead ECG

5 - Assess for red flags

20
Q

According to NICE guidelines, what are important aspects of the patient history to ask for syncope patients?

A

1 - Prodromal symptoms (early signs and symptoms they experienced)

2 - Loss of consciousness

3 - What are last and 1st things they recall?

4 - Previous episodes

5 - Injuries due to syncope

6 - PMH

7 - FM (any sudden deaths)

8 - Medications

21
Q

According to NICE guidelines, what are important aspects of the collateral history to ask for syncope patients?

A

1 - Circumstances of the event

2 - Posture immediately before loss of consciousness

3 - Appearance

4 - Presence or absence of movement during (limb-jerking?)

5 - Tongue-bitting

6 - Duration of the event (onset to regaining consciousness)

7 - Confusion during recovery

8 - Weakness on 1 side during recovery

22
Q

According to NICE guidelines, what are important aspects of the general examination for syncope patients?

A

1 - Vital signs (incl lying and standing blood pressure)

2 - Focussed neurological and cardiovascular examination

3 - Look for any injuries

23
Q

According to NICE guidelines, what are important features to look out for on a 12 lead ECG in a syncope patient?

A

1 - Inappropriate, persistent bradycardia

2 - Long QT (>450ms) and short QT intervals (<350ms)

3 - Abnormal T wave inversion

24
Q

According to NICE guidelines, what are considered red flags when assessing syncope patients?

A

1 - ECG abnormality (abnormal T-wave inversion, too long or short QT intervals, persistent inappropriate bradycardia)

2 - Heart failure (history of or physical signs)

3 - Onset with exertion

4 - Family history of sudden cardiac death at < 40 y.o.

5 - New or unexplained breathlessness

6 - Heart murmur

25
Q

What features of a syncope incident might indicate it was a seizure?

A

1 - A bitten tongue

2 - Head-turning to 1 side during episode

3 - No memory of abnormal behaviour that was witnessed before, during or after episode by someone else

4 - Unusual posturing

5 - Prolonged, simultaneous limb-jerking

6 - Confusion after event

7 - Prodromal deja vu

26
Q

What features of a syncope incident might indicate it was not a seizure?

A

1 - Prodromal symptoms which on other occasions have been abolished by sitting or lying down

2 - Sweating before the episode

3 - Precipitate by prolonged standing

4 - Pallor during the episode

27
Q

What are the most common tests performed on syncope patients?

A

1 - ECG

2 - Telemetry (remotely monitor vital signs)

3 - Measure cardiac enzymes

4 - CT scan

5 - Echocardiogram

6 - Postural BP

28
Q

What acute illnesses can bring on episodes of falls?

A

1 - Infection (chest, urinary)

2 - Dehydration

29
Q

What cognitive disorders are often associated with falls?

A

1 - Dementia (impaired judgement, adnormal gait)

2 - Delirium

3 - Depression/anxiety

30
Q

Deficiency of which vitamin is associated with falls?

A

Vitamin D

31
Q

Which medications can predispose a patient to increased risk of falls?

A

1 - SSRI’s

2 - Antipsychotics

3 - Anticholinergics/muscarinics

4 - Benzodiazepines

5 - Anti-hypertensives

6 - Diuretics

32
Q

Which healthcare team members are involved in assessing patients who are suffering with falls?

A

1 - Medical

2 - Nursing

3 - Physio

4 - OT’s

33
Q

What are the roles of the various healthcare team members who work with patients suffering from falls?

A

Medical - Visual impairement, falls history, osteoporosis risk, medications, cognitive impairment

Nursing - Cognitive impairment, urinary incontinence

Physio - Gait, balance, mobility and functional awareness

OT - Functional ability, Home hazards

34
Q

How are patients assessed for risk of osteoporosis?

A

1 - FRAX or QFRACTURE tool

2 - DEXA scan (measures BMD)

35
Q

How are patients with a high risk of osteoporosis treated?

A

1 - Calcium & Vit D supplement

2 - Bisphosphonates

3 - Denosumab

36
Q

What are the components of the FRAX assessment?

A

1 - Age, sex, weight, height

2 - Previous fractures

3 - Parent fractured hip

4 - Current smoker

5 - Taking glucocorticoids

6 - Rheumatoid Arthritis

7 - > 3 units alcohol/day

37
Q

What is sarcopenia?

A

The degeneritive loss of skeletal muscle mass and strength associated with ageing

38
Q

What are some of the complications of immobility?

A

1 - Muscle wasting

2 - Pressure sores

3 - DVT’s

4 - Osteoporosis

5 - Depression

6 - Social isolation

Specialities - Medicine of Old Age (6 decks)

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