Week 1 - Falls Flashcards
What are the 7 domains typically assessed in a comprehensive geriatric assessment (CGA) ?
- medical diagnoses
- review of meds
- social circumstances
- assessment of cognition and mood
- functional ability
- environmental assessment
- economic circumstances
What is the mnemonic that’s used to categorise causes of falls in the elderly ?
D - Drugs
A - Ageing
M - Medical problems
E - Environmental causes
What are some Drug categories that can cause falls ?
- antihypertensives
- sedatives
- opioids
- psychotropics
What are some causes of falls that are ‘Ageing’ related ?
- sarcopenia (muscle wasting with age)
- presbyopia (eye deterioration due to age)
- gait abnormalities
- cognitive decline
- slower reflexes
What are some common health conditions that can cause falls ?
- hypotension
- arrhythmias
- MI
- stroke
- parkinson’s
- epilepsy/seizures
- diabetic neuropathy
- diabetic hypos
- osteoarthritis
What does vertigo feel like?
like the room is spinning
What are some peripheral causes of vertigo ?
peripheral = ear/ear canal
- BPPV *(benign paroxysmal positional vertigo)
- menieres disease
- vestibular neuritis
- acoustic neuroma
What are some central causes of vertigo ?
central vertigo = vestibular pathways
- migraine
- brainstem ischaemia
- cerebellar stroke
- MS
What is BPPV described like by patients ?
- room is spinning
- short spells (up to a minute)
- settles spontaneously
- occurs when moves head
What is the most common type/cause of vertigo?
BPPV
benign paroxysmal positional vertigo
What can be used to diagnose BPPV ?
dix-hallpike manoeuvre
How do you do the Dix-hallpike manoeuvre ?
- 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
What can be used to treat BPPV ?
epley manoeuvre
How do you do the epley manoeuvre ?
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
What are the common causes of the symptom ‘dizzy’ described surrounding a fall?
- vertigo (BPPV)
- presyncopal/postural hypotension
- unsteadiness
- lack of confidence/fear of falling
How do you measure orthostatic hypotension ?
lying standing BP
What are some causes of transient loss of consciousness (T-LOC) ?
- orthostatic hypotension
- syncope = cardio dysfunction
- epilepsy = neuro dysfunction
- psychogenic attacks
What is transient loss of consciousness (T-LOC) ?
an abrupt loss of consciousness
- abrupt onset
- short duration
- complete recovery
How do patients often describe a transient loss of consciousness (T-LOC) ?
as a “blackout”
What systems need to be assessed in a falls patient ?
- neuro and cognition
- eyes and ears
- BP (lying standing)
- cardioresp
- MSK
what scoring system is used to assess for delirium ?
CAM score
What scoring system is used to assess a patients 10 year risk of hip fracture ?
FRAX calculator/score
How would you advise patients to take their oral bisphosphonates (alendronic acid) ?
- 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
What is a tinetti score ?
a score used to assess balance and gait in relation to fall risk
lower score = higher fall risk
What is the tinetti score scored out of ?
28
12 for gait
16 for balance
What are some age related changes that can contribute to increased falls risk ?
- 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
What is syncope ?
fainting
T-LOC due to transient global cerebral hypoperfusion
what is the cardiac output equation ?
heart rate x stroke volume
What is the blood pressure equation ?
cardiac output x peripheral vascular resistance
what are some of the mechanisms behind postural hypotension in the elderly ?
- 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
