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Geriatrics > Instability and Falls in Elderly Population > Flashcards

Instability and Falls in Elderly Population Flashcards

1
Q

The prevalence of falls among the elderly is linked to what?

A

increased morbidity and mortality

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2
Q

What can predispose an individual for future falls?

A

fear of falling

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3
Q

Balance confidence (perceived self-efficacy) is investigated fore its clinical implications for what?

A

fall screening and prevention stages

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4
Q

How many people 65+ fall every year?

A

1 out of 3 people

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5
Q

How likely is a person to fall again after experiencing a pervious fall?

A

twice as likely

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6
Q

Of the elderly that fall how many cause serious injury?

A

1 out of 5 falls cause serious injury

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7
Q

What is the leading cause of accidental death in the home?

A

Falls

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8
Q

what happens to an elderly patient who are hospitalized after a fall?

A

hospital stays are almost twice as long in elderly patient who are hospitalized after a fall than those admitted for other reasons

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9
Q

what % of people 65years old and over fall in a given year

A

35-40%

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10
Q

what % of people 80 years old and older fall in a year

A

50%

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11
Q

what % of people 65 years or older visit the ED because of a fall related injury?

A

8%

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12
Q

Falls account for what % of all fractures and what % of hip fractures in this group

A

falls account for 87% of all fractures and for more than 95% of hip fractures

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13
Q

What are risk Factors for Falling?

A 
Gait/Balance deficit
Visual/Hearing deficit
MSK impairment
Neuro/Cognitive Impairment
Depression
Using Assistive devices
Meds
Age>80 years old
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14
Q

What are Intrinsic Risk Factors for falls?

A 
Weakness, Fall Hx
Balance/Gait instability
Assistive device use
Visual Impairment
Arithritis, ADL deficits
Depression
Cognitive Impairment
Over 80 years old
Lifestyle factors
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15
Q

Where do most falls occur with the Elderly population?

What are environment risk factors for falls

A 
85% of falls occur in the Home RF:
clutter/hazards
support surface railing safety
Poor lighting
Obstacles
Clothing
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16
Q

what is the risk of falling in an elderly with 0-1 risk factors

A

27% risk of falling

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17
Q

what happens to a patient risk of falling if they have 4 or more risk factors

A

78% risk of falling

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18
Q

what is postural control

A

Maintaining balance during body movements requires a reaction to restore the person’s displaced center of mass over the base of support

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19
Q

what is needed to maintain adequate postural control

A

requires keeping COG and BOS (base of support) during both static and dynamic situations
the body must be able to respond to changes in COG d/t:
intentional movement
Involuntary or unexpected movement

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20
Q

postural control is dependent on what?

A

on the integration of visual, verstibular and proprioceptive input from the CNS

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21
Q

Loss of balance results from?

A
  • speed or magnitude of displacement
  • Inability to quickly detect the displacement b/c sensory impairment, slowing of the CNS sensory info into motor response
  • muscle weakness or joint pain causing slow motor response
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22
Q

motor strategies for postural control?

A

organized movement appropriate for controlling body’s position

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23
Q

sensory strategies for postural control?

A

organizes sensory info from visual somato-sensory, and vestibular systems for postural control

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24
Q

sensorimotor strategies

A

reflect rule for coordinating sensory and motor aspects of postural control

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25
Q

what are parts of anteroposterior stability?

A

ankle strategy
Hip strategy
stepping strategy

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26
Q

ankle strategy

A

response to small pertubation on a firm surface

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27
Q

hip strategy

A

response to larger faster pertubation on a smaller or compliant surface

28
Q

stepping strategy

A

response to strong pertubation, enough to displace COM outside Base of support

29
Q

Sensory input and balance

A

Vison is affected by age and disease
Hearing loss
Vestibular function
proprioception

30
Q

what happens with an elderly persons reaction time as their sensory input changes

A

as sensory information is decreased reaction time is significantly longer in older adults compared with young adults

31
Q

Central processing

A 
neurologic disease
Parkinsons
stroke
normal pressure hydrocephalus
dementia
depression- causes decreased concentration or awareness of potential environment hazards
32
Q

MSK affecting balance

A

Muscle mass/strength no longer capable of generating the strength and accuracy of response to a balance disturbance
Weakness of hip abductors/adductors- decreased ability to maintain balance while stepping to avoid a fall
Osteoarthritis- pain deformity, limited range or motion, affect ability to beak impact of fall
foor problems- calluses, bunions affect sensory input

33
Q

what happens to muscle strength as we age

A

strength declines with age for many adults
endurance decreases
muscle power is more highly correlated with physical function than muscle strength
Skeletal muscles loses both Type I&II fibers, number of motor units declines, number of myelinated fibers is reduced

34
Q

what happens with range of motion as we age

A

spinal flexibility shows greatest decline with age compared with all other joints (spinal stenosis, throacic kyphosis etc)
Ankle joint flexibility, critical for postural control declines
Neuromuscular system contributes to postural control

35
Q

Postural hypotension occurs in what percent of the elderly?

A

occurs in 10-30% of elderly community >65years old

36
Q

what is postural hypotension defined

A

drop in systolic BP of 20mmHg or more with change in position from lying to standing

37
Q

postural hypotension can be secondary to?

A

Meds
Dehydration
Age- associated with autonomic control of vasculature

38
Q

bandura described self efficacy as what?

A

person’s perception of their ability to master a given type or level of performance in certain settings.

39
Q

Tinetti decribed fear of falling as what?

A

as a diminished perceived self-efficacy at preventing a fall during normally non-hazardous activities of daily living.

40
Q

reduced self-efficacy for balance/ fear of falling can lead to?

A

self imposed restrictions to activity
deconditioning and loss of muscle mass
decreased mobility
fall-related anxiety which leads to muscle tension
Fear of falling can predispose an individual to future falls without ever having experienced a fall

41
Q

How do meds affects elderly’s risk of falls

A 
use of > 4 meds
impairs cognitive function
Electrolyte balance
BP
dizziness
fatigue
42
Q

what meds put elderly patients at risk for falls

A 
Anti-depressant
Diuretics
Neuroleptics/sedatives
Digoxin
Anti-arrhythmics
Sedative
Narcotic analgesics
Anti-HTN
43
Q

measurement of balance confidence/ self efficacy

A

first attempts to measure fear of falling used dichotomous variable: are you afraid of falling? Yes/No

44
Q

What does SAFE stand for

A

Survey of Activities and Fear of falling in Elderly.

Multiple level of questions on specific activities

45
Q

tools used to measurement of self-efficacy?

A

Falls Efficacy Scale (FES)

Activities-specific balance confidence scale (ABC)

46
Q

what is the ABC

A

Activities specific balance confidence scale
based on bandura’s concept of self efficacy and task avoidance
developed by powell and myers for community dwelling older adults
required subjects to rate their confidence in completing 16 activities of daily living

47
Q

ABC results/interpretation

A

overall confidence percentage is average of all 16 responses
-Scores 80% high functioning for active older adults
67% confidence level determined as falls risk with 84.4 sensitivity

48
Q

benefits of ABC

A

provides insight into fear of falling syndrome

facilitates active participation in interventions for falls risk reductions through acknowledgment of self-efficacy

49
Q

ABC limitations

A

not appropriate for all setting as some activities may not have been experienced by participant
not a replacement for physical performance measures

50
Q

what is the purpose of measurement of physical performance?

A

physical performance toll measures as person’s risk for falls
developed around assessing normal functional tasks that require good balance
need to be easily administered, evidence based and clinically significant

51
Q

what is the timed up and go (TUG)

A

developed as a measure of balance based on participants risk for falling
modified later to include timing and used to examine functional mobility in community dwelling, older adults 70-84 years of age

52
Q

how is the Timed Up and Go measured?

A

time is taken to rise to stand up from a chair walk 3 meters, turn, walk back to chair and sit down.

53
Q

TUG results/interpretation

A

older adults who take longer than 14 seconds have high risk of falls
other studies include TUG use in specific population/conditions
TUG score >16 seconds predicted falls in a 5yr period
TUG score of 24 or > for elderly persons post hip Fx valid predictor of fallin in the 1st 6 months after discharge

54
Q

disadvantage of TUG

A

researchers have found instructions for speed, number of trails, seat height and cuing varies in literature
Timing should commence with command “GO” but researchers found inconsistencies

55
Q

what is the Berg balance test

A

established by Berg as functional balance measure in geriatric patients

56
Q

How does the Berg balance test preformed?

A

14 balance items rated by observer on 5 points ordinal scale for each item
Participant cannot use assistive devices
Requires 10-20min and only requires minimal equipment
(2 chairs- one with arm rests and one without, foot stool/step, stop watch, ruler)
Can be used in pts who can not ambulate

57
Q

Benefits of berg balance test?

A

well known test: score may have meaning to multi-disciplinary team
may detect cognitive impairment because they may not be able to follow multi-step commands
valid measure in a variety of patient populations including stroke
looks at functional activities
low cost to administer

58
Q

Berg balance test results
41-56
21-40
0-20

A

41-56 Independent
21-40 walking with assistance
0-20 wheelchair bound

59
Q

What are multidisciplinary treatment in reducing risk factors for falling

A

Exercise/training to improve deficits in balance, mobility and strength
Correct sensory deficits (vision, hearing, vestibular, proprioceptive function)
Evaluate& Tx Hypotension
Review Meds
Treat foot problems
Environmental modification and use adaptive equipment
Education to patient and caretaker

60
Q

what are intervention strategies?

A

address physical status with interventions to address strength, balance, gait
Wellness,med review, life modifications
ED/Tx of medical conditions
reduce home hazards

61
Q

Interventions

A 
Modify home environment
Minimize Meds
Manage Postural hypotension
Manage foot problems
Strength, balance, gait training
proper hydration & nutrition
62
Q

How can fall risks be reduced

A 
repair uneven pavement
install railings
keep shrubs trimmed
remove throw rugs
remove clutter
keep cords near walls
Emergency call device
Adequate lighting 
Light switches at top and bottom of stairs
install grab bars in bath and near toilet
install raised toilet
use rubber matt in shower
do not use cupboards that are out of reach
63
Q

learning to fall

A

key is relaxation
more likely to roll with impact
more likely to sustain least amount of injury

64
Q

difficulty getting up after a fall

A

associated with substantial morbidity
51% of community dwelling elderly were unable to get up unassisted
85% of those who were not associated with serious injury
>20% remain on floor for >1hour

65
Q

how to reduce risk of hospital falls/ nursing home falls

A 
physical restraint
chemical restraint
bed alarms
call bell
low beds
arm bad to signify fall risk
Mats
scheduled toileting
use of assistive devices
66
Q

evaluation of a patient who fell

A 
unit personnel and healthcare providers are made aware in order to perform exam/tx
note associated symptoms
perform PE
Note any neuro findings or trauma
med review
lab or diagnostic studies
67
Q

Osteoporosis

A

Osteoporosis increases an older person’s risk of fracture

A decrease of one standard deviation in femoral neck bone mineral density increases the risk of hip fracture 2.7 times

Low body mass index and low weight increase the force of impact with a fall b/c of lack of cushioning effect of muscle and subcutaneous tissue

Geriatrics (9 decks)

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