Immobility & Falls Flashcards by Martin Beattie

What is the epidemiology of falls?

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

How well did you know this?

Not at all

Perfectly

In which age groups are falls the biggest problem?

80+’s

How well did you know this?

Not at all

Perfectly

What are the most common outcomes after a fall?

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

How well did you know this?

Not at all

Perfectly

What are the risk factors for falls?

1 - Muscle weakness

2 - History of falls

3 - Gait problems

4 - Balance problems

5 - Using a walking aid

6 - Visual deficit

How well did you know this?

Not at all

Perfectly

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

Intrinsic

Extrinsic

Situational

How well did you know this?

Not at all

Perfectly

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

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

2 - Syncope (cardiac or vagal)

3 - Chronic disease (neurological or MSK)

4 - Visual problems

How well did you know this?

Not at all

Perfectly

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

1 - Medications

2 - Alcohol

3 - Urgency of micturition

How well did you know this?

Not at all

Perfectly

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

1 - Inappropriate footwear

2 - Environmental hazards

3 - Poor lighting

How well did you know this?

Not at all

Perfectly

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

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

2 - Posture & balance

How well did you know this?

Not at all

Perfectly

What are the stages of controlling balance?

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

How well did you know this?

Not at all

Perfectly

How are gait and balance assessed in elderly patients?

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

How well did you know this?

Not at all

Perfectly

Which medical conditions could cause dizziness in an elderly patient?

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

How well did you know this?

Not at all

Perfectly

What are the broad categories of causes of syncope?

1 - Neurally-mediated

2 - Orthostatic hypotension

3 - Cardiac arrythmias

4 - Structural cardiac

5 - Cerebrovascular

How well did you know this?

Not at all

Perfectly

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

1 - Vasovagal syncope (common faint)

2 - Carotid sinus hypersensitivity

How well did you know this?

Not at all

Perfectly

What are some of the causes of orthostatic hypotension?

1 - Autonomic failure

2 - Volume depletion (haemorrhage, diarrhoea)

How well did you know this?

Not at all

Perfectly

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

Sinus node dysnfunction
AV conduction disease

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

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

What is subclvian steal syndrome

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

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

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

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

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

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

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

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

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

2 - Focussed neurological and cardiovascular examination

3 - Look for any injuries

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

1 - Inappropriate, persistent bradycardia

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

3 - Abnormal T wave inversion

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

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

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

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

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

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

What are the most common tests performed on syncope patients?

1 - ECG 2 - Telemetry (remotely monitor vital signs) 3 - Measure cardiac enzymes 4 - CT scan 5 - Echocardiogram 6 - Postural BP

What acute illnesses can bring on episodes of falls?

1 - Infection (chest, urinary) 2 - Dehydration

What cognitive disorders are often associated with falls?

1 - Dementia (impaired judgement, adnormal gait) 2 - Delirium 3 - Depression/anxiety

Deficiency of which vitamin is associated with falls?

Vitamin D

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

1 - SSRI's 2 - Antipsychotics 3 - Anticholinergics/muscarinics 4 - Benzodiazepines 5 - Anti-hypertensives 6 - Diuretics

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

1 - Medical 2 - Nursing 3 - Physio 4 - OT's

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

**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

How are patients assessed for risk of osteoporosis?

1 - FRAX or QFRACTURE tool 2 - DEXA scan (measures BMD)

How are patients with a high risk of osteoporosis treated?

1 - Calcium & Vit D supplement 2 - Bisphosphonates 3 - Denosumab

What are the components of the FRAX assessment?

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

What is sarcopenia?

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

What are some of the complications of immobility?

1 - Muscle wasting 2 - Pressure sores 3 - DVT's 4 - Osteoporosis 5 - Depression 6 - Social isolation