Lecture 10: Falls and Immobility Flashcards
What is a significant risk factor for future falls?
A previous history of falls
What is associated with increased risk of falls?
- Chronic MSK pain (worse pain = higher risk)
- Cognitive impairment
- Medication use (MODIFIABLE RISK FACTOR)
At what age do over half of all people fall?
over age 80
What is the general major risk factor for falls?
Mobility
What are the most serious of injuries due to falls and how often do they occur?
Half of all falls result in Hip fractures, head trauma, and C-spine fractures
What sort of additional stress may cause an older adult to fall and why?
- Acute illness, new med, environmental hazards
- Older patients cannot compensate as well as a younger person
What are the 4 strongest risk factors for falling?
- Previous Falls
- Decreased muscle strength
- Gait and balance impairment
- Specific medication use
What are the aspects of normal walking?
Controlling balance and posture at both rest and movement
What are the main concerns with soft tissue trauma due to falls?
- Hematomas
- Anticoagulant use
- Infection
- Wound care at home
What are the common fractures and which of them is the worst?
- Hip, wrist, humerus, and ribs
- Hip is the worst: 1/3 of patients > 65yo will die w/in a year if they get one.
What direction do old people fall in that result in hip fractures?
Sideways
How should we approach closed head injuries in geriatric pts?
- Concussion: low threshold to admit
- SDH: Admit at a neuro faciility and check for other injuries.
What is the most important thing to ask a geriatric patient post-fall?
Why did u fall?
What usually precipitates an accidental fall?
Environmental hazards
What is a functional reach test and what is considered moderate/severe fall risk?
- Tests for how far you can reach forward without taking a step or losing balance
- 6-10 inches = Moderate fall risk
- Less than 6 inches = severe fall risk
What kind of footwear predisposes one to falls?
- High heels
- Floppy slippers
- Slick soles
- Ill-fitted shoewear
What makes a good shoe?
- Upper shoe is soft, flexible, and smooth
- Toe has a little wiggle room
- Sole should be strong and flexible
- Heel should be broad and no higher than 4cm
- Fastening should be somewhat flexible to accommodate odd shaped feet or swelling
What are the modifiable risk factors for fall prevention?
- Muscle strength
- Gait and balance
- Medication use
- Visual acuity
- Depression
- Pain
- Dizziness
What do CT and MRI r/o in a person with a neurologic finding post fall?
- Stroke
- Mass
- Normal pressure hydrocephalus
- Structural abnormalities
What is the standard diagnostic evaluation for an older patient at risk for falling?
Just standard medical workup. There’s no set workup protocol.
Define immobility.
State in which an individual has a limitation in independent, purposeful physical movement of the body or of one or more lower extremities
What can small improvements in mobility provide?
- Decrease incidence and severity of complications
- Improve patient’s well-being
- Decrease cost and burden of caregiving
What is the one of the most common complications of immobility?
Pressure ulcers
What are the 4 stages of a pressure ulcer?
- Stage 1: No blanching when pressed, unbroken skin, often over a bony prominence
- Stage 2: looks like an abrasion or blister, extends past dermis into the fat
- Stage 3: Looks like a crater, full thickness down to subQ fat but not past underlying fascia. necrotic and foul smelling
- Stage 4: Bone is visible
