Primary Care - Falls and Old Age Flashcards
What does staying upright involve
Sensory input mechanisms
Brain input
Muscle input
Why do people fall
Disease
Alcohol
Medication
Environmental factors
Diseases and falls
Eye Middle ear Brain Nerve Muscle Joints Others - orthostatic hypotension, acute MI/ stroke
Eye diseases and falls
Cataracts
Macula degeneration
Middle ear diseases and falls
BPPV
Menieres
Brain diseases and falls
Stroke
Parkinson’s
Nerve diseases and falls
Diabetes (peripheral neuropathy)
Muscle diseases and falls
Muscle wasting
Joint diseases and falls
OA/ trauma/ deformity
Drugs and falls
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
Environment and falls
Loose carpet Clutter Rugs Wet flood Pets Poor lighting Clutter
Age related issues causing falls
Vison Sensation Vestibular system Brain Muscle
Age related issues with visions causing falls
Reduced acuity/depth perception/ dark adaptation
Age related issues with sensation causing falls
Reduced proprioception/sensation on foot
Age related issues with vestibular system causing falls
Slows down
Age related issues with brain causing falls
Slows —> slower reaction time
Age related issues with muscle causing falls
Reduced strength, mass and slower contraction
How does age related issues increase fall risk
Increased sway
Flexed posture
Slower, shorter steps and less time on one leg
More steps
Falls prevention team
(MDT) - OT, physio etc Home-based exercise programme Expected to exercise 3x a week 1 yr follow up 30-46% reduction in falls
Preventing falls
Falls prevention team
GP - medication review
Social services
Examples of opioids
Codeine Morphine Tramadol Oxycodone Fentanyl Dihydrocodeine Pethidine
Types of opioids
Natural/ non-synthetic - derived from opium poppy Synthetic - made in a lab Semi-synthetic
Examples of natural opioids
Morphine
Codeine
Examples of synthetic opioids
Fentanyl
Methadone
Examples of semi-synthetic opioids
Oxycodone
When might we use opioids
Post op In labour End of life Cancer treatment Trauma Short term post injury
Common side effects of opioids
Confusion Constipation Drowsiness - increases falls risk Headaches Hallucinations Arrhythmia Nausea Respiratory depression Urinary retention
Medical care of older pts
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
How do older pts present differently
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
The over 75 check - hx
Urinary symptoms e.g. incontinence
Constipation
Mobility/ falls
Exercise
The over 75 check - examination
Pulse BP Height Weight Hearing, vision, mobility
The over 75 check - ix
Glucose
Others led by their chronic conditions
