Week 4 Falls Flashcards
Define a Fall
“an event that results in the individual coming to rest
inadvertently on the ground or floor or other lower
surface”
- WHO
Define Los Of Balance
Unsteadiness when sitting, standing, or walking that may result in a fall.
Describe the epidemiology of falls in australia
- how much is it costing the Healh care system
- Falls for >65yrs cost the health system $83 million in 2001-2002, approximately 1.5% of the health expenditure in WA.
- Projected to reach $1,375 million annually by 2051
Significance of Falls
- Falls and the associated fractures are a significant cause of morbidity and mortality amongst the elderly population.
- Falls related deaths are the 6th most common cause of death amongst elderly population
- 75% of people who die from a fall are over the age of 65
Explain the cyclical nature of the Fear Of Falling
Person has a fall > Fear of Falling > Loss of confidence > decrease in physical & social activity > balance & walking deteriorate > risk of falling increases
leads right back around to another fall
DDx for Loss of Balance and Falls
Balance can be affected by diseases involving
- Cognition, Alertness, Motivation and Planning
Traumatic causes
Inflammatory causes
Metabolic causes:
Vascular causes
Congenital causes
Neurogenic/psychogenic causes
DDx for Dizziness
Degenerative causes
Tumor causes
List some common traumatic causes of loss of balance and falls
Benign paroxysmal positional vertigo (BPPV)
Traumatic brain Injury
List some uncommon and rare inflammatory causes of loss of balance and falls
Uncommon
- Aseptic
- Labyrinthitis/Neuronitis
- MS*
- Septic
- Encephalitis
- Menningitis
Rare
- Paraneoplastic syndrome
List some common and rare metabolic causes of loss of balance and falls
Common
- Diabetic neuropathy
Rare
- Vestibular ototoxicity
List some common, uncommon and rare vascular causes of loss of balance and falls
Common
- CVA*
- Orthostatic hypotension*
Uncommon
- Cerebral Aneurysm
- TIA*
Rare
- Vasculitis*
- Wallenberg’s syndrome*
- VBAI*
List some common congenital causes of loss of balance and falls
hydrocephalus
List some common and uncommon Neurogenic/Psychogenic causes of loss of balance and falls
Common
- Peripheral Neuropathy*
Uncommon
- Meniere’s disease*
- Neurological complications of
- AIDS
List some common and uncommon degenerative causes of dizziness
Common
- Parkinson’s Disease
Uncommon
- Dementia with Lewy bodies
List some uncommon and rare tumor causes of dizziness
Uncommon
- Brain and Spinal Primary
- Brian and Spinal
- Secondary
- Benign: NA
Rare
- Acoustic Neuroma
- Angiomatosis
- Neurofibromatosis
List some INTRINSIC risk factors of falls
- Previous Falls
- Balance
- Mobility
- Cognitive impairment
- Incontinence
- Medications
- Vision
- Dizziness and Vertigo
- Syncope
List some EXTRINSIC risk factors of falls
- Obstacles or crowded environment
- Poor house design
- Poor lighting
- Slippery surfaces, loose surfaces
- Inappropriate assistive devices or heights of chairs
- Feet or poor fitting shoes
What is the role of a Chiropractor in the management and prevention of falls
Identify risk factors
- Balance and mobility
- Vertigo and dizziness
- Education or referral
- Feet/footwear
- Continence
- Risking behaviours
- Managing falls risks
- HEP
- Referral
- Medication review or vision test?
Hx questions on Falls
- Falls or near falls
- Where?
- What happened immediately preceding fall
- Was it witnessed?
- “were you able to get up after the fall?”
- Environment – trips, slips.
- Other factors – lighting, rushing, footwear or walking aids
What screening tests would you perform to assess balance and mobility in the elderly?
Functional reach test - 25cm.
6m Walk Test - >6seconds
TUG >12-15 seconds
Berg Balance <40
FTSST >12 seconds
How would you manage the health status of an elderly person with cognitive impairment?
- Regular physical activity
- Environmental modifications/hazard minimisation
- Maintain hydration and nutrition
- Osteoporosis Ax/Mx
- Medication consolidation where possible.
How and why would you manage continence in relation to falls
people will take risk to avoid an incontinence episode
Management:
- Continence screening/assessment
- Fluid intake management
- Habit training/timed voiding
How can poor footwear increase falls risk and how can it improve balance
Poor footwear increases falls risk:
- Poor fitting
- Lack of fixation (laces, buckles)
- High heels
- Slippers
- Socks (non grip)
Good footwear improves balance:
- Thin soles improve foot position
- Low square heel improves balance
- Supportive collar improves balance
how do you medically assess SYNCOPE
temporary loss of consciousness caused by a fall in blood pressure
- ECG, echocardiogram
- Holtermonitor
- Tilt table tests
Decrease in systolic BP > 20mmHg supine to standing after 2/3 minutes is suggestive of
orthostatic hypotension.
