L10: Falls in Older People Part 1 Flashcards
What is a fall?
“….an unexpected event in which the participant comes to rest on the ground, floor, or lower level….”
What is an injurious fall?
considers only peripheral fractures of the limb girdles and limbs
What is the problem with falls?
Falls can cause secondary injuries include traumatic brain injury
- Falls –leading cause of TBIs in Australia
What is a slip?
A slip occurs due to the sliding of the supporting leg underneath you
What can trips and slips lead to?
Lead to a fall if balance is not regained
What are 3 examples of how a slip can occur?
- Slippery floors
- Ill-fitting footwear
- Bare foot (with loss tactile and sensory feedback)
What is a trip?
A trip occurs due to the impact of the swinging leg with an external object or body part….
Why are there differences between incidence of falls in different countries? What are 5 reasons?
- Infrastructure ○ Housing
- Average age of population of country (life expectancy)
- Physical activity levels
- Physical de-conditioning /inactivity - falls
- Access to healthcare
- Environmental factors Ice and snow in colder climates
____ are the leading cause of injury in adults >65 years.
Falls
Falls are ____ % of injury-related death
20
What is the most common injury as a result of a fall in the older population?
Hip fractures
What are 8 most common injuries requiring hospitalisation as a result of falls?
#
- hips
- pelvis
- leg
- radius
- ulna
- humerus
- neck
- ribs
Why is the fractured neck of femur the most serious injury due to a fall?
Damage to femoral artery = avascular necrosis (blood supply is cut off to the bone)
What are 3 problems with fractures due to falls?
- Damage to femoral artery
- Avascular necrosis
- Death
- Poor recovery/mobility
What occurred in this image?
Incorrect weight shifting while walking forward
Tried avoid stepping on the dog
What occurred in this image?
Trip while walking forward
What occurred in this image?
Trip while walking and turning In sufficient cross over step
What occurred in this image?
Incorrect weight shift while standing and turning
Turned the body before the frame
- Affected weight shift and posture
What occurred in this image?
Loss of support with external object when sitting down No breaks on wheelchair when sitting
What are 3 characteristics of the retrospective process of recording falls?
- No. falls over defined period of time
- Usually 12mths
- ↓ accuracy in recalling falls over prolonged period
What are 3 characteristics of the prospective process of recording falls?
- Individuals followed up for a period
- Usually 12mths
- ↑ accuracy in determining incidence of falls
What are 4 recommendations when reporting falls?
- Prospective daily recording and notification system
- Minimum of monthly reporting
- Missing data –telephone or face-to-face interview
- Circumstances of falls determined with additional questions
- Location of falls
- How did you fall
- Signs and symptoms
- Any injuries
What is a long lie?
“…remaining on the ground or floor for more than an hour after a fall…”
What are 3 things that long lie a marker for?
- weakness
- illness
- social isolation
What are 6 things that the time spent on the floor in a long lie is associated with?
- Fear of falling
- Muscle damage (impact on ground)
- Hypothermia
- Pneumonia
- Pressure sores (unable to adjust body)
- Dehydration/malnutrition
What is the problem with a long lie?
High mortality rates
50% of those who lie on the floor for ≥1hr die within 6mths (even if no direct injury from fall)
What are 8 falls risk factors?
- Medication
- Sensory and neuromuscular
- Gait characteristics
- Psychological
- Postural Stability
- Environmental
- Medical
- Demographic
What are 3 demographic risk factors for falls?
- Gender
- Age
- Race/Ethnicity
What are 3 statistics/characteristics of gender as a demographic risk factors?
- Fall rates higher in community-dwelling women (40%) vs men (28%)
- Women: ↑rate of non-fatal injuries &hospitalisation
- Decline in function following a fall
- Men:↑rate of fatal falls
What are 2 statistics/characteristics of age as a demographic risk factors?
- Fall rates ↑exponentially >65 years of age
- Falls-related mortality ↑in those >80 years
What is a statistic/characteristic of race/ethnicity as a demographic risk factors?
Higher rate of falls in White populations vs Japanese, Blacks, Americans, Hispanics, & Asian/Pacific Islanders
Why is there a higher rate of women with non-fatal injuries and hospitalisation?
Neuromuscular balance is worst in women than men
Why is there a higher rate of men with fatal falls?
Due to the type of exercise that is done
- More laborious work (outside)
Why are there differences in race and ethnicity with falls (ie. why is it poorer outcomes and greater injury severity in the white population?)
- Differences to access to health care
- Genetics
- Bone mineral density = injuries sustained
What are 3 environmental risk factors for falls?
- Community
- Hospital
- Aged Care/Residental Crea
What are 6 statistics/characteristics of community as an environmental risk factors?
- Private home, low-acuity community health services
- 50% falls within own home/immediate surroundings
- Level surfaces in commonly used rooms (bedroom, lounge, kitchen)
- Proportion of falls involve environmental hazards (rugs, slippery floor)
- Most falls occur during maximum periods of activity in morning or afternoon
- Related to exposure
- To activity
- To environment
- Only 20% falls occurring between 9pm-7am
What are 4 statistics/characteristics of hospital as an environmental risk factors?
- No distinction between injuries occurring before & after admission
- ~8% of falls-related overnight admissions do not return home
- ↑Risk offalls upon entry into a health care facility
- 15% of older people fall within a month of discharge
What are 4 statistics/characteristics of RAFC as an environmental risk factors?
- Falls: one of the major factors precipitating admission to RACFs
- Most commonly due to tripping, slipping and stumbling (~22%)
- Bedside and bathroom most common sites for falls
- Womenhave more falls in RACFs (~24%) than men(~18%)
- Incident rates: vary according to case mix
- 4-10 falls per 1000 resident bed days
- Up to 50% of all residents experience ≥1 falls/year
- 22% of falls in a RACF require hospitalisation
What are 2 reasons why there is an increase in falls once in a hospital?
- Unless unable to mobilise (bed-ridden)
- Already a in a weaken state (eg. delirium) –> introduction to unfamiliar situation/environment
What is a demographic risk factor for falls?
Previous falls
What are 2 characteristics of medical risk factors?
- Multiple chronic illnesses: ↑likelihood of falls ◦ Occasional fallers more than twice as likely to have >3 medical conditions compared to non–fallers
- Individual disease processes can lead to an increased risk of falling via more than one physiological mechanism…
Many diseases increase the risk of falling by impacting directly on physiological systems. What are 3 parts that can be affected?
What are 2 examples of sensory input problems as a medical risk factor?
- Cataract
- Diabetics
What are 3 examples of central processing problems as a medical risk factor?
- Parkinson’s
- Dementia
- Delirium
What is an example of effector response problems as a medical risk factor?
OA
What is Parkinson’s disease?
Dopamine deficiency (from SNC)
- Impairs basal ganglia loop
- Dopamine important for controlling movement
What are 3 characteristics of idiopathic PD?
- Disease duration
- Disease severity
- Independent risk factors
What are 3 characteristics of dopamine (Neurotransmitter) deficiency in PD?
- Altered motor control
- Inefficient postures
- Impaired movement
What are 4 characteristics of PD?
- Flexed, stooped (Thoracic kyphosis) posture
- Rigidity, Tremor
- Shuffling gait
- Freezing while walking
- Difficulty initiation movement
- ↓Trunk rotation/arm swing
- Abnormal gait
- ↓Stride length
- ↓Foot clearance
- When negotiating obstacles
- Impaired postural responses
- External perturbation
What are 2 characteristics of CV insufficiency in PD?
- ↓ Cerebral Perfusion
- Postural Hypotension
How does diabetes affect the sensory input and the effector response?
- Diabetic reticulopathy
- Diabetic neuropathy
How does OA affect the sensory input and the effector response?
What is Postural (orthostatic) hypotension?
Positional changes which lead to falls
Abnormal fall in blood pressure within 3 mins of standing upright from supine
Don’t need both to drop
- Systolic: ↓at least 20mmHg
- Diastolic: ↓at least 10mmHg
What are 2 common causes of Postural (orthostatic) hypotension?
- Conditions leading to hypovolaemia
- Loss of fluid from the body (eg. blood loss); kidney problems
- Medications
- Vasodilators, Diuretics
- Loss of fluids
- Vasodilators, Diuretics
What are the 3 effects of Postural (orthostatic) hypotension?
- Dizziness
- Light headedness
- Faintness
_____ hypertension or hypotension can be a medical risk factor for falls.
uncontrolled
What are 3 types of cardiac arrhythmias that is a medical risk factor for falls?
What are 3 reasons why incontinence is a medical risk factor for falls?
- Rushing to toilet (urge): loss of balance/ tripping over obstacles
- ↑Likelihood of slipping on urine
- Larger the volume of urine lost, greater the risk of falls
What are 2 characteristics of incontinence as a medical risk factor for falls?
- Urge & stress incontinence associated with ↑risk of falls in community-dwelling older adults >70 years
- Falls & incontinence reported to be associated with physical limitations and ↓quality of life
What is polypharmacy?
‘Multiple medication prescribing’
Multiple drug use –predictor of falls
Risk of community-dwelling elders falling
What are 2 side effects of medication which is a medical risk factor for falls?
- Interactions between medications
- Ageing can affect Pharmacokinetics and Pharmacodynamics
What is Pharmacokinetics?
Ingestion, absorption, digestion and excretion
What is Pharmacodynamics?
Action of drug (is it doing what it is intended to do)
Often have changes in liver = drugs might not have intended effect
What are 2 cardiovascular medication which are medical risk factors?
Diuretics
Anti-hypertensive agents
- Ace inhibitors
- B-blockers
What are 2 reasons of why diuretics are a medical risk factor for falls?
- Capacity to cause volume depletion & postural hypotension
- Induceincontinence →risk factor for falls
What is the action of the antihypertensive agents (Ace inhibitors)?
Decrease peripheral vascular resistance (doesn’t increase CO, C rate, C contractibility)
What are 5 side effects of antihypertensive agents (Ace inhibitors)?
- Dizziness (risk factor)
- Orthostatic hypotension (risk factor)
- GI distress
- Nonproductive cough
- Headache
Why are antihypertensive agents a risk medical risk factors
Side effects they have when taken
What is the action of the antihypertensive agents (B blocks)?
Blocks beta receptors in the heart which cause a decreased HR, force of contraction and rate of AV conduction
What are 6 side effects of antihypertensive agents (Ace inhibitors)?
- Bradycardia (risk factor)
- Lethargy (risk factor- difficulty clearing step)
- GI disturbance
- CHF
- Decreased BP
- Depression (risk factor)
Why are psychotropics a risk factors? What are 3 key side effects?
- Delirium
- Postural hyptension
- Arrhythmias
What are 3 types of centrally acting medications?
- Benzodiazepines
- Antidepressants
- Anti-psychotics
What are 5 effects of Benzodiazepines? Why is this a medical risk factor?
- ↑Risk of falls: institutionalised &; community-dwelling elders
- Impaired reaction times
- ↓Joint position sense (toes)
- ↑Postural sway
- Nocturnal disorientation
What are 5 effects of Antidepressants? Why is this a medical risk factor?
- Depression –risk factor for falls
- Antidepressants –can increase risk of falling
- Underlying disease or treatment?
- Altered temporospatial and kinematic gait parameters
- Impaired obstacle clearance?
Are analgesics (eg antiinflammatories- NSAIDS/corticosteroids) medical risk factors?
Not a falls risk factor–> only when combined with other medication
What are 7 foots and ankle problems?
- Corns/Calluses
- Hallux Valgus
- Hammer Toes
- Disabling Foot Pain
- Weak Toe Muscles
- ↓ Tactile sensitivity
- ↓ Ankle Flexibility
What are 4 precursors for ankle and foot problems?
- Osteoarthritic ↓in joint ROM
- Poor footwear
- Dermatological conditions
- Systemic diseases
What is the evidence between ankle and foot problems and falls?
- More common in fallers v non-fallers
- Associated with ↓ balance, mobility, functional ability, ↑ risk of falls
Why is inefficient toe flexors a risk factor for falls?
- When you fall often grip toes
- With weak toe muscles –> unable to do this
What are 3 examples of peripheral sensation/proprioception impairments as a sensory risk factors?
- Diabetes (Neuropathy)
- Degenerative Joint Disease
- Vitamin B12deficiency
What are 4 examples of vestibular pathologies as a sensory risk factors?
- Direct trauma
- Infection
- Cerebellar ataxia
- Manifest as vertigo/dizziness
What are 3 examples of visual impairments as a sensory risk factors?
- Cataracts / Glaucoma
- Macular Degeneration
- Visual Field Deficits
