OP: Falls and Frailty Flashcards
Patient’s PC: a fall.
What would you ask in Hx?
WHO saw you fall?
WHEN did you fall?
WHERE did you fall?
WHAT happened before/during/after?
WHY do you think you fell?
HOW many times have you fallen?
Meds taken? How do they mobilise usually?
What PMH may be relevant in fall Hx?
CVS - arrhythmia, CVD
Resp - COPD
Neuro - Parkinson’s, peripheral neuropathy, stroke, dementia
GU - UTIs, incontinence
GI - Diverticulitis, chronic D-, ALD
MSK - Arthritis, chronic pain, fractures
Why review meds in OP who has had a fall?
Polypharmacy is RF for falls. Meds have SE for increasing risk of falls.
Name meds that increase risk of falls in OP
BBlockers
DM meds
HTN meds
Benzodiazepines
Abx
What bloods do you need to request for a confusion screen for your patient? And what looking for?
FBC (e.g. infection, anaemia, malignancy)
U&Es (e.g. hyponatraemia, hypernatraemia)
LFTs (e.g. liver failure with secondary encephalopathy)
Coagulation/INR (e.g. intracranial bleeding)
TFTs (e.g. hypothyroidism)
Calcium (e.g. hypercalcaemia)
B12 + folate/haematinics (e.g. B12/folate deficiency)
Glucose (e.g.
hypoglycaemia/hyperglycaemia)
Blood cultures (e.g. sepsis)
What score can we use in a clinical setting to evaluate for frailty?
Rockwood clinical frailty score >65yrs
Some steps to prevent delirium?
avoid drugs that cause: opiates / benzodiazepines
asses factors that cause: pain control / drugs
Identify those at risk and monitor
use supportive and environmental management approaches for all patients
Bedside investigations for OP that has Hx of fall?
Vital signs - BP, HR, RR, O2 sats, temp
Lying and standing BP (orthostatic hypotension)
Urine dip (blood ++ in rhabdo)
ECG - bradycardia, arrythmia
Cognitive screen
Blood glucose (Hypoglycaemia)
Blood investigations to do for OP w/ Hx of fall?
FBC
U+Es - dehydrated, electrolyte abnorm, rhabdo
LFTs - chronic alcohol use
Bone profile - Ca levels in malignancy, over supplementation of Ca
Imaging investigations for Op w/ Hx of fall?
CXR
CT head
Echo
Use surgical sieve / systems review to AR causes of falls in OP
CVS - arrhythmia, ortho hypoT, Bradycardia, valvular heart disease
Neuro - Stroke, peripheral neuropathy
GU - Incontinence, UTI
Endocrine - Hypoglycaemia
MSK - Arthritis, Disuse atrophy
ENT - BPPV, ear wax
How are OP who have fallen assessed?
Falls risk assessment
- ID people over 65 who have had 1+ falls in last 12/12.
- Take full Hx
- note RF
- assess gait and balance - use Timed Up and Go test +/- Turn 180deg test.
See CKS Nice guidance - falls risk assessemnt
Commonly offered interventions for OP with recent falls Hx?
Strength and balance training
Home hazard assessment and intervention
Vision assessment
Medication review
What is frailty?
Frailty is a syndrome of age-associated declines in physiologic reserve and function across multiorgan systems. This leads to increased vulnerability for adverse health outcomes
Is frailty a disease?
NO- frailty it is the inability to withstand physical / psychological stressors.
can occur on a background of natural ageing or be triggered by disease.
What are the common features of frailty (Frailty Phenotype)?
Weakness - measure grip strength
slowness (walking speed)
low level of physical activity
Feeling of exhaustion
unintentional weight loss >5kg in 1 year.
What patient groups is it useful to assess for frailty?
Surgical patients
Cardiovascular disease
cancer
HIV
What are pts with frailty more at risk of?
Falls
Anxiety
depression
unplanned hospital admissions
What are the two models of frailty ?
Frailty Phenotype - features e.g. weight loss, exhaustion etc.
Rockwood - looks at accumulation of deficits (e..g loss of hearing, dementia, tremor) which combine to increase ‘ frailty index’
How do you prevent frailty?
Physical activity (resistance exercise) to counteract loss of skeletal muscle function - sarcopenia.
Diet - enough protein / calories
Vitamin D - ensure not deficient
What are the 5 frailty syndromes- raise suspicion that pt has frailty (prev: Geriatric Giants)
Falls
Immobility (e.g. sudden change ‘stuck in toilet’)
Delirium
Incontinence (change / new onset / worsening)
Susceptibility drug side effects (e.g. confusion with codeine, hypotension with antidepressants).
After you have recognised a patient with frailty, how should they be managed?
A comprehensive Geriatric Assessment
A holistic review looking at:
Optimising current illnesses
Individual Goal setting
Drug review
Care planning - personalised escalation, end of life care, advanced planning
Multidisciplinary team members:
Geriatrician
Occ therapist / community carer
Mental health / social worker
Specialist nurse
