Primary Care - Falls and Old Age Flashcards

1
Q

What does staying upright involve

A

Sensory input mechanisms
Brain input
Muscle input

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2
Q

Why do people fall

A

Disease
Alcohol
Medication
Environmental factors

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3
Q

Diseases and falls

A
Eye 
Middle ear 
 Brain 
Nerve 
Muscle 
Joints 
Others - orthostatic hypotension, acute MI/ stroke
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4
Q

Eye diseases and falls

A

Cataracts

Macula degeneration

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5
Q

Middle ear diseases and falls

A

BPPV

Menieres

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6
Q

Brain diseases and falls

A

Stroke

Parkinson’s

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7
Q

Nerve diseases and falls

A

Diabetes (peripheral neuropathy)

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8
Q

Muscle diseases and falls

A

Muscle wasting

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9
Q

Joint diseases and falls

A

OA/ trauma/ deformity

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10
Q

Drugs and falls

A

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

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11
Q

Environment and falls

A
Loose carpet 
Clutter
Rugs 
Wet flood 
Pets
Poor lighting 
Clutter
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12
Q

Age related issues causing falls

A
Vison
Sensation 
Vestibular system 
Brain 
Muscle
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13
Q

Age related issues with visions causing falls

A

Reduced acuity/depth perception/ dark adaptation

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14
Q

Age related issues with sensation causing falls

A

Reduced proprioception/sensation on foot

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15
Q

Age related issues with vestibular system causing falls

A

Slows down

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16
Q

Age related issues with brain causing falls

A

Slows —> slower reaction time

17
Q

Age related issues with muscle causing falls

A

Reduced strength, mass and slower contraction

18
Q

How does age related issues increase fall risk

A

Increased sway
Flexed posture
Slower, shorter steps and less time on one leg
More steps

19
Q

Falls prevention team

A
(MDT) - OT, physio etc 
Home-based exercise programme 
Expected to exercise 3x a week 
1 yr follow up 
30-46% reduction in falls
20
Q

Preventing falls

A

Falls prevention team
GP - medication review
Social services

21
Q

Examples of opioids

A
Codeine 
Morphine 
Tramadol 
Oxycodone 
Fentanyl 
Dihydrocodeine
Pethidine
22
Q

Types of opioids

A

Natural/ non-synthetic - derived from opium poppy Synthetic - made in a lab Semi-synthetic

23
Q

Examples of natural opioids

A

Morphine

Codeine

24
Q

Examples of synthetic opioids

A

Fentanyl

Methadone

25
Q

Examples of semi-synthetic opioids

A

Oxycodone

26
Q

When might we use opioids

A
Post op 
In labour 
End of life
Cancer treatment 
Trauma 
Short term post injury
27
Q

Common side effects of opioids

A
Confusion 
Constipation 
Drowsiness - increases falls risk 
Headaches 
Hallucinations 
Arrhythmia 
Nausea 
Respiratory depression 
Urinary retention
28
Q

Medical care of older pts

A

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

29
Q

How do older pts present differently

A

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

30
Q

The over 75 check - hx

A

Urinary symptoms e.g. incontinence
Constipation
Mobility/ falls
Exercise

31
Q

The over 75 check - examination

A
Pulse 
BP
Height 
Weight 
Hearing, vision, mobility
32
Q

The over 75 check - ix

A

Glucose

Others led by their chronic conditions