Week 7 (after midterm) Flashcards
balance involves the integration of which 4 systems?
- visual
- vestibular
- somatosensory
- musculoskeletal
ability to maintain balance requires adequate what?
reaction time
name 2 righting mechanisms of balance.
- postural sway
- vestibular righting response
balance is restored using which 4 adjustments?
- ankle, knee, and hip adjustments
- stepping
the pattern of ___ ___ for balance differs in older adults.
muscle activation
approx. what percent of adults 65 and older fall each year?
30%
what percent of older adults suffer moderate to severe injuries including hip fractures and head trauma from falling?
20-30%
the risk for falls increases with age, rises steadily after which age?
75
name 13 common causes of falls.
- decline in visual, auditory, and vestibular system
- slower reaction time
- inadequate LB strength
- decreased joint flexibility
- medications
- specific diseases
- postural changes
- incontinence
- demands of the task
- behaviors
- gait changes
- environment
- fear of falling
contributes to fall risk
fear of falling (FOF)
name 7 components that can affect fear of falling.
- female gender
- gait disorder
- impaired physical function
- use of a mobility aid
- previous falls
- depressive symptoms
recognized as important and preventable but may not be viewed as personally relevant
senior’s perceptions of fall risk
___ ___ are perceived as likely causes of falls, but not other factors.
environmental features
which types of falls are more likely to be precipitated by environmental causes?
outdoor falls
when do outdoor falls usually occur?
while walking in a particular area and in the presence of others
name 6 predictors of indoor falls.
- physical disability
- deficits in ADLs
- medication use
- cognitive impairment
- depression
- low falls efficacy scale scores
name 7 predictors of outdoor falls.
- male
- younger age
- depressive symptoms
- psychotropic medications
- moderate to high alcohol consumption
- fast gait speed
- frequent participation in leisure time physical activity
the ___ ___ contributes to perceived fall risk and fear of falling.
built environment
name 5 consequences of falls.
- physical injuries
- long lies
- self imposed restriction in activity
- increases likelihood of dependency and institutionalization
- social isolation
name 4 AGS/BGS guidelines.
- older adults who have fallen should have an assessment of their gait and balance
- older adults who present for medical attention bc of a fall, report recurrent falls in the past year, or report difficulties in walking balance should have a multifactorial fall risk assessment
- multifactorial fall risk assessment should be performed by a clinician with appropriate skills and training
- the multifactorial fall risk assessment should be followed by direct interventions tailored to identified risks
name 4 aspects of an assessment per AGS/BGS clinical guidelines.
- focused history
- physical function tests
- functional assessment
- environmental assessment
history of falls, medications, risk factors: arthritis, incontinence, pain, hypertension, self-rated health)
focused history
balance, gait, mobility, lower extremity strength, visual acuity, feet & footwear, cognition, cardiovascular status
physical function tests
ADL, fear of falling
functional assessment
- operationalizes AGS/BGS guidelines
- includes algorithm for screening and assessment, fact sheets, functional assessments
CDC Steadi Initiative
- measures concern about falling during physical and social activity (indoors and outdoors)
- likert scale ranging from “not at all concerned” to “very concerned”
- ex: walking on an uneven surface, getting up from a chair, taking a bath, going shopping, cleaning the house
falls efficacy scale international (FES-I)
- measure of physical mobility
- used as a fall risk screening tool
- stand from a chair, walk 3 meters, turn around come back and sit down. time measured in seconds
timed up and go (TUG)
- “yard stick” is secured to the wall at the height of the right acromion
- client is asked to stand with feet apart, make a fist and place arm parallel to measuring device. placement of the end of the 3rd metacarpal is recorded. client asked to reach as far forward as possible without taking a step or losing their balance. placement at the end of the third metacarpal is recorded again.
functional reach test
what indicates a fall risk on the functional reach test?
less than or equal to 6 inches
- fourteen item assessment of static and dynamic balance
- sit to stand, standing unsupported, sitting with back unsupported, stand to sit, transfers, standing unsupported with eyes closed, etc.
berg balance test
- designed to be used by any health professional in home, hospital or primary care setting
- abbreviated version of original tool with items most predictive of fall risk included
FROP-Com screen
name the 3 items included in the FROP-Com screen.
- fall history
- balance
- ADL
what is the purpose of the 30-second chair stand test?
to test leg strength and endurance
name the equipment used in the 30-second chair stand test.
- a chair with a straight back without arm rests
- seat 17 inches high
- stopwatch
- community-based, OT led 7-week program with follow-up home visit and 3 month booster
- group-based intervention that includes: balance and strength exercises, home hazards, community safety and footwear, vision and falls, vitamin D and calcium, hip protectors, medication management, and mobility mastery
- group sessions include reflection, sharing accomplishments, homework assignments, action planning
stepping on
what is the % reduction of falls for Stepping On program participants as a result of increased protective behavior practices?
31%
a home eval. is effective for those with what 2 things?
- low vision
- high risk of falls
__ __ is effective in reducing risk of falls, but less so for those at high risk.
tai chi
exercise programs that reduce falls primarily involve ___ and ___ exercises.
balance, functional
programs that are likely to reduce falls include ___ ___ ___.
multiple exercise categories
name the sequence of regaining balance.
- ankle adjustment
- knee adjustment
- hip adjustment
why is decline in hearing a risk factor for falls?
awareness of environment is different - someone is telling you to watch out and you don’t hear them, hearing loss is linked to cognitive status which can cause falls, can’t hear signals in environment, feet sound different on different floors
why is decreased joint flexibility a common cause of falls?
limited knee or ankle range when climbing up a step
name 5 specific diseases that can be risk factors for falls.
- OA - specifically knees
- Parkinson’s
- Diabetes - neuropathy, vision
- status post CVA/stroke
- dementia - wandering, poor safety awareness
why are postural changes a common cause of falls?
center of gravity is more forward
why is incontinence a common cause of falls?
rushing to the bathroom
describe proper footwear.
- heal should not be higher than an inch
- heal counter should be pretty firm
- laces are better than slip-on shoes
people don’t clear their toe as well and often get caught
toe off
describe senior’s perceptions of fall risk.
- less likely to identify their own vision, balance, or muscle strength as fall risks
- identify environmental factors more
name a risk for indoor falls.
multiple medications
name a risk for outdoor falls.
moderate to high alcohol consumption - head injuries, don’t have good reaction time
name 4 personal strategies used to adapt to fall risks.
- change their gait
- lift up feet when walking
- walking around metal grates
- use of social environment to decrease risk - crossing guards, asking strangers to help them, following groups of young people to walk in a group
name 2 barriers to physical activity and exercise.
- dog walkers
- going to a local gym but the level of class is not for you
exercise programs online or at local gyms - can participate in classes or get a membership
silver sneakers program
name 3 unmet educational and training needs for knowledge of outdoor fall risks and prevention practices.
- didn’t understand the risks associated with wearing progressive glasses
- didn’t recognize stairs as being problematic
- didn’t understand how to carry items safely - better if hands are free - backpacks are good if you’re carrying lightweight items
muscle wasting from being in an extended period for too long
rhabdomyolyses
full on assessment for one’s fall risk - assessed by clinicians
multifactorial fall risk assessment
how do you calculate reaction time on the Ruler Drop Test?
take the square root of 2 times gravity divided by distance in meters
what is the cut off score for the TUG (timed up and go) test?
14 secs - if someone tasks more than 14 seconds = high fall risk
how many seconds on the TUG indicates need for AD and ADL assistance?
more than 30 secs
what is a limitation of the TUG?
will pick up older, more frail people but doesn’t tell us much about people at risk for falling outside (fast walkers)
checklist given to client or family member to look at their home environment and make sure there are no hazards
CDC “Check for Safety”
combines interview with observation and task performance, takes an hour to complete - time consuming, looks at abilities to safely store food, smoke detectors, etc.
SAFER-HOME v3
44 cards with pictures, person is asked to sort the cards into piles into things they don’t do and don’t want to do, things they do now with no problem, things I want to do but have trouble doing, things I want to do but don’t do, ranked from least to most important
I-HOPE
worn under clothes, significantly reduce risk of hip fractures
hip protectors
one on one, for one person, addresses all impairments or risks identified
multifactorial assessment
group-based programs, single-component - one on one focuses on one aspect
multicomponent assessment
name 3 effective medical interventions to reduce fall risks.
- pacemakers
- cataract surgery
- medication adjustments
name 6 steps for assessing someone with a fall.
- interview - fall(s) history
- questions about home environment
- vision and hearing from chart or ask questions
- cognitive screen (ex: MOCA)
- self-report measure - fall efficacy scale
- performance measure - TUG or BERG
when can the TUG not be used?
if someone requires physical assistance (from OT or other)
name some ways to provide interventions to prevent fall risk for clients with dementia at an adult day health center.
- chair yoga/tai chi/modified exercise program - part is seated and part is holding onto back of chair
- educating staff on fall prevention risks
- modifying the environment
- home assessments - help caregivers make the environments as safe as possible
who is the Stepping On program good for and who is it not good for?
good for individuals in the community, not good for individuals with dementia
what does a higher score on the FES-I indicate?
greater fear of falling
name 3 ways to address fear of falling.
- pt. education - if you do fall, what is the safest way to get up, safety alert gadgets
- help establish different routes or times to travel
- self-advocate for any issues or problems in the community
