Overview of Falls

Question 1

describe the epidemiology of falls

Answer 1

30-40% community dweller above 65 fall yearly
40-60% no injury
30-50% minor injury

Question 2

balance/stability definition

Answer 2

the ability to control the centre of mass (COM) relative to the base of support (BOS)

Question 3

give definition of instability

Answer 3

An inability to control the COM relative to the BOS

Question 4

what are the causes of instability

Answer 4

Motor system - peripheral or central
Sensory system - peripheral or central
Cognitive input - executive function

Question 5

what is steady state stability

Answer 5

control the COM relative to the BOS in unperturbed conditions.

Question 6

what is reactive balance

Answer 6

ability to recover from an unexpected perturbation.

Question 7

what is proactive balance

Answer 7

ability to activate muscles for balance in advance of a potentially destabilising movement in order to avoid instability.

Question 8

list examples of geriatric syndromes

Answer 8

dementia delirium depression
gait and mobility impairment
incontinence
frailty
iatrogenic complications e.g. constipation and pressure ulcers

Question 9

consequences of impaired balance control

Answer 9

decreased functional independence
risk of falls
fear of falling
avoidance - inactivity

Question 10

definition of a fall

Answer 10

Unexpected displacement when subject comes to rest unintentionally on the ground’.

Failure of body to remain upright

Question 11

how are fallers classified

Answer 11

depends on frequency of falls
occasional faller
recurrent faller
at risk of falling
injurious fall
non-injurious fall

Question 12

what are the 2 categories for risk factors of falls

Answer 12

extrinsic -relate to environment and task
intrinsic - relate to person

Question 13

list the intrinsic factors for falls

Answer 13

medical - postural hypotension, CVS, 4 medications including sedatives,
muscle weakness - nutrition and disuse
visual impairment - cataract, macular degeneration, diabetic retinopathy
previous falls hx
cognitive impairment
sensory impairment
gait, balance deficit

Question 14

possible causes of dizziness

Answer 14

Vestibular disease
Cerebrovascular
Cardiovascular
Syncope*
Carotid sinus hypersensitivity*
Drop attacks*
Cardiac - arrhythmia

Question 15

what to consider as visual risk factors for falls

Answer 15

acuity
contrast sensitivity
depth perception

Question 16

what is acuity

Answer 16

a measure of the ability of the eye to distinguish the details of object

Question 17

what is contrast sensitivity

Answer 17

ability to distinguish between finer and finer increments of light versus dark (contrast)

Question 18

what is depth perception

Answer 18

your eyes’ ability to judge the distance between two objects.

Question 19

what could be possoble environmental factors to falls

Answer 19

Surfaces
Hazards
Obstacles
Lighting
Footwear & clothing

Question 20

what objects could be considered risk falls for falls

Answer 20

Loose rugs / slippery floors / heating / broken steps / uneven surfaces
Steps / rails
Lighting / trailing flexes
Footwear
Other - clothing / behaviour
Other / pets

Question 21

what is long lie

Answer 21

older person is unable to get up after a fall,

Question 22

what is long lie usually associated with

Answer 22

high mortality, fear of falling, muscle damage, pneumonia, pressure sores, continence and dehydration.

Question 23

signs of post fall syndrome

Answer 23

Fear of falling
Functional decline
Loss of independence
Spiral of inactivity
Depression and social isolation
Impact on quality of life

Question 24

risk factors for hip fracture

Answer 24

decreased activity
gait/balance disorder
decreased BMD
increased age
previous fal
visual problem
medications
low body weight

Question 25

what prevention strategies to prevent hipf fractures

Answer 25

increase BMD - medications e.g. calcium/Vi t D, bisphosphonate
weight bearing exercise
mobility and stability issue
decrease falls risk
safe footwear

Question 26

examples of balance assessments

Answer 26

berg balance scale
timed up and go test
tinetti assessment
single leg stance test
rhomberg

Question 27

what questions are asked for falls history

Answer 27

have you fallen
when
frequency
where
time
activity taking place when falling
how did you lose balance
anyone else present
able to get up
injury
previous falls in last month, 3 /12, 6/12

Question 28

goals for physiotherapy management of falls

Answer 28

prevent future falls
train to cope with falls
how to get up after falls
confidence and education

Question 29

physio management for falls

Answer 29

gait aid
balance re-ed
muscle strengthening
increase confidence
footwear
vision, hearing, balance