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Y4 Geriatrics > Week 1 - Falls > Flashcards

Week 1 - Falls Flashcards

1
Q

What are the 7 domains typically assessed in a comprehensive geriatric assessment (CGA) ?

A
  1. medical diagnoses
  2. review of meds
  3. social circumstances
  4. assessment of cognition and mood
  5. functional ability
  6. environmental assessment
  7. economic circumstances
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2
Q

What is the mnemonic that’s used to categorise causes of falls in the elderly ?

A

D - Drugs
A - Ageing
M - Medical problems
E - Environmental causes

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3
Q

What are some Drug categories that can cause falls ?

A
  • antihypertensives
  • sedatives
  • opioids
  • psychotropics
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4
Q

What are some causes of falls that are ‘Ageing’ related ?

A
  • sarcopenia (muscle wasting with age)
  • presbyopia (eye deterioration due to age)
  • gait abnormalities
  • cognitive decline
  • slower reflexes
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5
Q

What are some common health conditions that can cause falls ?

A
  • hypotension
  • arrhythmias
  • MI
  • stroke
  • parkinson’s
  • epilepsy/seizures
  • diabetic neuropathy
  • diabetic hypos
  • osteoarthritis
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6
Q

What does vertigo feel like?

A

like the room is spinning

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7
Q

What are some peripheral causes of vertigo ?

A

peripheral = ear/ear canal

  • BPPV *(benign paroxysmal positional vertigo)
  • menieres disease
  • vestibular neuritis
  • acoustic neuroma
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8
Q

What are some central causes of vertigo ?

A

central vertigo = vestibular pathways

  • migraine
  • brainstem ischaemia
  • cerebellar stroke
  • MS
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9
Q

What is BPPV described like by patients ?

A
  • room is spinning
  • short spells (up to a minute)
  • settles spontaneously
  • occurs when moves head
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10
Q

What is the most common type/cause of vertigo?

A

BPPV

benign paroxysmal positional vertigo

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11
Q

What can be used to diagnose BPPV ?

A

dix-hallpike manoeuvre

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12
Q

How do you do the Dix-hallpike manoeuvre ?

A
  • sit patient upright on bed
  • cross arms over chest and ask Pt to keep eyes open throughout
  • position head looking at you at about 45° from midline
  • check for nystagmus
  • lay patient down
  • extend head back/down off the back of couch about 20°
  • check for nystagmus (can take up to a minute)

nystagmus = positive test = BPPV

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13
Q

What can be used to treat BPPV ?

A

epley manoeuvre

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14
Q

How do you do the epley manoeuvre ?

A

following from the dix-hallpike manoeuvre…

  • wait for nystagmus to correct
  • turn Pt head from the 45° to right over to the same on left
  • ask Pt to roll onto left side, as they roll guide head to maintain 45° angle for them
  • ask Pt to swing legs over side of couch to sit up
  • Pt lowers chin to chest while sitting up
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15
Q

What are the common causes of the symptom ‘dizzy’ described surrounding a fall?

A
  • vertigo (BPPV)
  • presyncopal/postural hypotension
  • unsteadiness
  • lack of confidence/fear of falling
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16
Q

How do you measure orthostatic hypotension ?

A

lying standing BP

17
Q

What are some causes of transient loss of consciousness (T-LOC) ?

A
  • orthostatic hypotension
  • syncope = cardio dysfunction
  • epilepsy = neuro dysfunction
  • psychogenic attacks
18
Q

What is transient loss of consciousness (T-LOC) ?

A

an abrupt loss of consciousness

  • abrupt onset
  • short duration
  • complete recovery
19
Q

How do patients often describe a transient loss of consciousness (T-LOC) ?

A

as a “blackout”

20
Q

What systems need to be assessed in a falls patient ?

A
  • neuro and cognition
  • eyes and ears
  • BP (lying standing)
  • cardioresp
  • MSK
21
Q

what scoring system is used to assess for delirium ?

A

CAM score

22
Q

What scoring system is used to assess a patients 10 year risk of hip fracture ?

A

FRAX calculator/score

23
Q

How would you advise patients to take their oral bisphosphonates (alendronic acid) ?

A
  • on empty stomach
  • 30 mins before breakkie and other meds
  • swallowed while with water
  • sit upright to take and remain upright for 30mins after swallowing

for 3-5yrs

if patient isn’t capable of this then IV or SC preparations are available to be taken every 3months

24
Q

What is a tinetti score ?

A

a score used to assess balance and gait in relation to fall risk

lower score = higher fall risk

25
Q

What is the tinetti score scored out of ?

A

28

12 for gait
16 for balance

26
Q

What are some age related changes that can contribute to increased falls risk ?

A
  • sarcopenia
  • postural instability
  • decreased bone mineral density
  • visual changes
  • decreased baroreceptor sensitivity leading to orthostatic hypotension
  • loss of fast twitch muscle fibres
  • slower reflexes
  • reduction in proprioception
27
Q

What is syncope ?

A

fainting

T-LOC due to transient global cerebral hypoperfusion

28
Q

what is the cardiac output equation ?

A

heart rate x stroke volume

29
Q

What is the blood pressure equation ?

A

cardiac output x peripheral vascular resistance

30
Q

what are some of the mechanisms behind postural hypotension in the elderly ?

A
  • reduced baroreceptor sensitivity decreasing rate of BP increase when standing
  • less effective RAAS causing reduced blood volume via excess salt wasting
  • left ventricular diastolic dysfunction causing inability to increase strove volume effectively
  • loss of pace maker cells decreasing cardiac performance

Y4 Geriatrics (6 decks)

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