Lecture 17 - Falls In The Elderly

Question 1

Frequenc of falls

Answer 1

• 1 in 3 aged >65
• higher in hostels and nursing homes
• 20-25% of patients aged 65+ in ED

Question 2

Number of fractures in females

Answer 2

• hip fractures increases with afe

- colles and humeral fractures decreases with age

Question 3

Complications of falls

Answer 3

• head injuries - subdural, contusions
• soft tissue injuries
• long lie complications: dehydration, rhabdomyolysis, pneumonia, pressure ulcers
• disability: decrease mobility due to physical injury, decrease self confidence
• institutionalisation

Question 4

Falls as a geriatric syndrome

Answer 4

• falls occur in older people who are predisposed because of the accumulated effects of multiple disease and impairment which limits their ability to compensate when exposed to a precipitating insult or challenge

Question 5

Predisposed impairment in the elderly

Answer 5

• dementia/cognition
• vision
• gait/balance
• muscle weakness
• proprioception

Question 6

Precipitating factors in the elderly

Answer 6

• multi medication,
• acute illness,
• post hospitalisation
• postural hypotension
• displacing activity
• environment

Question 7

What stops people from falling

Answer 7

• sensory input: visual, vestibular, proprioception
• central processing: cerebrum, cerebellum, basal ganglia, brain stem
• MSK: balance, locomotion

Question 8

Conditions that can disrupt those factors

Answer 8

• sensory input: cataract, diabetes
• Central processing: dementia, stroke, parkinson
• MSK - osteoarthritis

Question 9

__ of people fall because of an acute medical event

Answer 9

1/3

Question 10

Symptoms and signs:

Answer 10

• Syncope: loss of consciousness, amnesia to the event
• dizziness and unsteadiness
• orthostatic hypotension
• gait
• neurological

Question 11

Screening questions and assesment

Answer 11

• recurrent falls
• difficulty in walking or balance
• fear of falling
• present to ED or clini with more than 1 fall
• single fall with a fait or balance deficit

Question 12

Yale FISCIT

Answer 12

• multi-factor intervention
• exercise
• medication
• OT

Question 13

Prevention

Answer 13

• home hazards, OT review
• psychotropic drug withdrawal
• exercise focusing on strength and balance
• vision

Question 14

What kind of exercise has the most benefit

Answer 14

• balance > strength > endurance/aerobic
• individual exercise for the frail, group exercise for the well elderly
• Tai chi

Question 15

Vision treatment

Answer 15

• bifocals increase falls risk

- cataract surgery decreases fall rate and fractures