Lectures Flashcards
def: birth rate
no. of live births per 1,000 women in age group 15-44
def: total fertility rate
expected no. of children born per woman in child-bearing years
def: replacement level
no. of children required to join population to replace each couple
def: perinatal mortality rate
no. stillbirths and deaths of infants under 1 wk per 1,000 live and stillbirths
def: expectation of life at birth
average no. years which new born baby can be expected to survive if current mortality rates continue
def: lying and standing BP postural hypotension
systolic drop >20mmHg
diastolic drop >10mmHg
causes of falls
- ↓vision
- ↓righting reflexes
- ↓balance
- ↓ muscle strngth
- ↓joint mobility
- impaired sensory sustems
- cVS system problems
- neurological disease
- peripeheral neuropathy
- cognitive decline
- postural hypotension
- non-compliance with walking aid
falls risk assessment
- assess gait, balance and mobility and muscle weakness
- assess osteoporosis risk
- assess perception of functional ability and fear of falling
- assess vision
- assess cognitive impaitment and neuro exam
- assess urinary incontinence
- assess home hazards
- CVS exam and meds review
falls injuries
- fractures
- had injuries
- laceration
- bleeding
- bruising
- LOC
risks with long lie
- hypothermia
- dehydration
- rhabdomyolysis
- pneumonia
- pressure ulcers
- delirium
management of falls
- focus on injuries an healing initially
- rrehabilitation - improve confidence, mobility and safety
- MDT input
- bone health
- falls education
what happens balance in ageing
loss of cilia insemicircular canals, utricle and saccule vestibular system
progressive decline in baroreceptor function
conditions increasign risk of falls
- acute infection/sepsis (UTI, GIT, chest)
- parkinson’s disease
- stroke
- MS
- meniere’s disease
- diabetes
- peripheral vascular disaese
- chronic disease of MSK
medication in falls
- psychotropic drugs
- analgesics
- CVS drugs
medicaiton in falls: psychotropic drugs
- sedatives
- hypnotics
- anxiolytics
- antidepressants
- anticonvulsants
medication in falls: analgesics
- codeine
- opioids
medication in falls: CVS
- alpha blockers
- beta blockers
- diuretics
- antihypertensives
- ACE/ARB
- Ca channel blockers
- nitrates
def: carotid sinus hypersensitivity
exaggerated response to carotid sinus baroreceptor stimulation - syncope may occur due to transient reduced cerebral perfusion
what is CSH associated with
hypertension
Lewy body dimentia
IHD
medication
what to ask in syncope history
driving hx and document in notes
def: BPpV
benign paroxismal positional vertigo
what test is used in BPPV
dix halpike and epley manouvre
tx: BPPV
physio - balance excercises and muscle stregthening
stop night sedation
adequate fluid intake
how to measure lying and standing blood pressure
- ensure pt lies in bed for 5 mins
- get them to stand and take blood pressure immediately
- repeat after 3 minutes
- should be first thing in morning
def: postural hypotension
systolic drop >20mmHg
diastolic drop >10mmHg
Q: pt presents with recurrent syncopal episodes occuring ontransition from sitting to standing or following porolonged periods of standing. Which of the following is the most appropriate immediate investigation?
A. 24hr ECG recording
B. carotid sinus massage
C. CT brain
D. erect and supine blood pressures
E. head-up table test
D. erect and supine BP
Q: 82 y/o pt presents with recurrent falls witnessed by daughter. Each occasion witnessed to stumble or trip before falling to ground. One occassion tripped over edge of rug, once fell while getting out of car and most recently fell out of bath. Not been noticed to lose consciousness. Which are indicated?
A. occupational therapy assessment
B. social work assessment
C. 24 hour ECG tape
D. erect and supine BP
E. urinalysis
F. medication review
A occ health
D erect and supine BP
F medication review
Q: what %age of falls result in hip fracture
A. 10%
B. 25%
C. 33%
D. 1%
E. 5%
D. 1%
Q: which of the following drugs may be associated with falls?
a. Gliclazide
b. Bendroflumethiazide
c. Fludrocortisone
d. Amitriptyline
e. All of the above
A gliclazide
B bendroflumethiazide
D amitriptyline
Q: which of the following category of persons have highest fall related mortality worldwide?
a. Females >70 years of age in Western countries
b. Females in the low- and middle- income countries of Europe
c. Males in the low- and middle- income countries of Europe
d. Males > 75 years old in Middle income Western countries
e. Females >65 in Africa
c
Q: 7. Which of the following interventions have been shown to prevent falls in community dwelling older adults?
a. Surgery for recurrent cataract
b. Insertion of a permanent pacemaker of 1st degree heart block
c. Exercise programmes targeting balance
d. Tai Chi
e. Insertion of a permanent pacemaker for cardioinhibitory carotid sinus hypersensitivity
D and E
Q: which of the following can increase falls risk?
a. Hypovitaminosis D
b. Steroid use
c. Simvastatin
d. Atypical antipsychotics
e. Contact lens use (no but bifocals can)
f. Urinary incontinence
A, B, D and F
Q; which of the following can results in gait impairment?
a. Dementia
b. Depression
c. Hallux valgus
d. Indwelling urethral catheter
e. Sensory polyneuropathy
f. Thyrotoxicosis
A, C, D, and E
Q: which of the following are intrinsic risk factors for falls?
a. Nitrazepam
b. Macular degeneration
c. Bifocal glasses
d. Cataracts
e. Parkinsons disease
B, D and E
Q: which of the following forms of excercises reduce falls risk
a. Chair exercises
b. Swimming
c. Tai Chi
d. Using an exercise bike
e. Walking groups
C
5 geriatric giants
- immobility
- intellectual impairment
- incontinence
- instability
- (iatrogenesis)
Factors affecting brain in ageing
- cerebral atrophy
- ischaemia
- amyloid, tau
- temperature regulation
- pain perception
- thrist
- sleep-wake
- mood disorders and social isolation
Factors affecting senses in ageing
- presbyopia
- cataracts
- ARMD
- senile ptosis
- ectropion
- glaucoma
- presbyacusis
- impacted ear wax
- BPPV
- reduces taste and smell
Factors affecting lungs in ageing
- smoking
- kyphoscoliosis
- reduces gas exchange
- fibrosis
- emphysema
Factors affecting heart liver and kidneys in ageing
- atherosclerosis
- AF
HTN
aortic stenosis
diastolic dysfunction/CCF
decreased drug clearance
CKD
alcohol
Factors affecting bowel with ageing
- constipation
- diverticular disease
- presby-esophagus
- vaginal prolapse/stress
- BPH
- UTIs
- postmenopausal vaginal atrophy
- reduced bladder capacity
Factors affecting bones and joints in ageing
- osteoporosis and fractures
- calcification and calcinosis
- vitamin D deficiency
- sarcopenia
- osteoarthritis
def: frailty
clinically recognisavle state of increased vulnerabilty from ageing associated decline in reserve and function across multiple physiological systems such that the abiloty to cope with everyday or acute stressors is compromised
Things to assess in frailty
- reduced muscle strength and tolerance
- sarcopenia
- reduced gait speed
- low energy/physical activity
- unintentional weight loss
Tools to assess frailty
PRISMA 7 questionnaire
timed up and go test
polypharmacy
PRISMA 7 questionnaire
- are you >85?
- male?
- any health problems that limit activities?
- need someone to help on a regular basis?
- any health problems requiring you to stay at home?
- in case of need can you count on someone close to you?
- do you regularly use a stick, walker or wheelchair?
Comprehensive Geriatric Assessment
- Medical diagnosis
- Medications
- Nutrition
- Swallow
- Vision
- Hearing
- Bladder
- Bowel
- Cognition
- Mood
- Skin
- Mobility
- ADLs
- Carer support/ family
- Home environment
Areas in CGA?
- physical health
- mental health
- functional status
- social functioning
- environment
Physio measuring sclaes
- sitting balance
- sit to stand
- 10 second TUSS ((time unsupported steady stand)
- timed up and go
- trunk impairment sclae
- functional reach
- turn 180 test
- berg balance
- selective finger movement
- modified rivermead mobility index
what is a swallow disorder medically called
oro-pharygneal dysphagia
signs of dysphagia
- coughing and choking
- eye watering
- wet voice/breathing
- wheeze or increased RR
- holding food in mouth too long
- drooling
- inability to swallow medication
subtle signs of dysphagia
loss of wright
dehydration
recurrent chest infections
SLT management of swallow
- food and fluid modification
- equipment - cups and straws
- swallow manouvres and positioning
- education
- tube feeding
def: aphasia
multimodal condition affecting one or all communication abilities - understanding, reading, writing, gesture, speech
language centres of brain cannot send or receive signals
def: dysarthria
motor speech disorder resulting from distrbance in muscular control of speech
def: dysphasia
disorder of language - thoughts and ideas cannot become spoken
def: dysfluency
stammering, - interruptuon of flow of articulation
def: dyspraxia
disorder of motor peech planning - messages from the brain to mouth are disrupted, articulation imapired even though muscles are not weak
def: dysphonia
both vocal cords not moving efficiently causing disturbances to quality of voice heard
Extrinsic fall factors mnemonic
STUMBLING
Stuff (clothes, shoes, furniture)
Trailing wires
Uneven, wet, polished floors
Mobility problems (rolator)
Bad lighting
Loose rugs
Ill fitting footwear
Nocturnal low temp
Glare and shadow
Intrinsic falls factors
- postural hypotension
- cardiac (MI/ arrhythmia)
- valvular heart disease
- vasovagal
- TIAs/strokes
- dizziness
- epilepsy
- cervical spndylosis
- visual impairment
- brain sidease/dimentia
non pharmacological falls management
adequate dies
weight bearing excercise
stop smoking
reduce alcohol
pharmacological falls management
- bisphosphonates
- denosumab (rank ligand inhibitor for bone health)
- teriparatide (osteoporosis)
- SERMs
- Strontium
- HRT
features of history and examination indicating vertebral fracture
