Primary Care - Falls and Old Age

Question 1

What does staying upright involve

Answer 1

Sensory input mechanisms
Brain input
Muscle input

Question 2

Why do people fall

Answer 2

Disease
Alcohol
Medication
Environmental factors

Question 3

Diseases and falls

Answer 3

Eye 
Middle ear 
 Brain 
Nerve 
Muscle 
Joints 
Others - orthostatic hypotension, acute MI/ stroke

Question 4

Eye diseases and falls

Answer 4

Cataracts

Macula degeneration

Question 5

Middle ear diseases and falls

Answer 5

BPPV

Menieres

Question 6

Brain diseases and falls

Answer 6

Stroke

Parkinson’s

Question 7

Nerve diseases and falls

Answer 7

Diabetes (peripheral neuropathy)

Question 8

Muscle diseases and falls

Answer 8

Muscle wasting

Question 9

Joint diseases and falls

Answer 9

OA/ trauma/ deformity

Question 10

Drugs and falls

Answer 10

Benzodiazepines - e.g. diazepam, zopiclone etc
Blood pressure agent - acei/ccb etc
Angina medication - nitrates (decrease blood pressure)
Diuretics e.g. furomeside in HF
Poly pharmacy —> 4 or more drugs

Question 11

Environment and falls

Answer 11

Loose carpet 
Clutter
Rugs 
Wet flood 
Pets
Poor lighting 
Clutter

Question 12

Age related issues causing falls

Answer 12

Vison
Sensation 
Vestibular system 
Brain 
Muscle

Question 13

Age related issues with visions causing falls

Answer 13

Reduced acuity/depth perception/ dark adaptation

Question 14

Age related issues with sensation causing falls

Answer 14

Reduced proprioception/sensation on foot

Question 15

Age related issues with vestibular system causing falls

Answer 15

Slows down

Question 16

Age related issues with brain causing falls

Answer 16

Slows —> slower reaction time

Question 17

Age related issues with muscle causing falls

Answer 17

Reduced strength, mass and slower contraction

Question 18

How does age related issues increase fall risk

Answer 18

Increased sway
Flexed posture
Slower, shorter steps and less time on one leg
More steps

Question 19

Falls prevention team

Answer 19

(MDT) - OT, physio etc 
Home-based exercise programme 
Expected to exercise 3x a week 
1 yr follow up 
30-46% reduction in falls

Question 20

Preventing falls

Answer 20

Falls prevention team
GP - medication review
Social services

Question 21

Examples of opioids

Answer 21

Codeine 
Morphine 
Tramadol 
Oxycodone 
Fentanyl 
Dihydrocodeine
Pethidine

Question 22

Types of opioids

Answer 22

Natural/ non-synthetic - derived from opium poppy Synthetic - made in a lab Semi-synthetic

Question 23

Examples of natural opioids

Answer 23

Morphine

Codeine

Question 24

Examples of synthetic opioids

Answer 24

Fentanyl

Methadone

Question 25

Examples of semi-synthetic opioids

Answer 25

Oxycodone

Question 26

When might we use opioids

Answer 26

``` Post op In labour End of life Cancer treatment Trauma Short term post injury ```

Question 27

Common side effects of opioids

Answer 27

``` Confusion Constipation Drowsiness - increases falls risk Headaches Hallucinations Arrhythmia Nausea Respiratory depression Urinary retention ```

Question 28

Medical care of older pts

Answer 28

Chronic, multiple diagnoses and their complications. Managing vs curing Organ failure e.g. heart failure, chronic kidney disease, liver failure Senses decline Reduced homeostatic mechanisms Reduced resistance to infection The social hx

Question 29

How do older pts present differently

Answer 29

Pts become ill quickly at the extremes of age. Unlike children, older pts recover slowly Non-spp presentation e.g. ‘off legs’, a fall, confusion, breathlessness No symptoms

Question 30

The over 75 check - hx

Answer 30

Urinary symptoms e.g. incontinence Constipation Mobility/ falls Exercise

Question 31

The over 75 check - examination

Answer 31

``` Pulse BP Height Weight Hearing, vision, mobility ```

Question 32

The over 75 check - ix

Answer 32

Glucose | Others led by their chronic conditions