Falls and their consequences Flashcards
Give some stats on falls: ? living at home will fall at least ?
In the elderly, if someone ?, we class them as ?
1 in 3 >65yrs and half of over 80s living at home will fall at least once a year
In the elderly, if someone falls 2 times or more in a year, we class them as a recurrent faller
Why do we fall?
falls can occur due to intrinsic factors (e.g. medical reasons like syncope) or extrinsic factors (e.g. bumps)
To determine the cause of a fall, we can use the mnemonic ACE:
A: Age related changes
C: Co-morbidities (including medications)
E: Environment
Which age related changes increase the risk in falls
L
S + V
S
K
- Loss of neurones, brain atrophy + demyelination
- Sensory + vestibular impairment (reduced sensation for fine touch, vibration, proprioception, and balance)
- Sarcopenia-> less able to fix unintentional movements
- Kyphosis–> body weight shifts towards the ground, making falls more likely
How is gait also affected by age?
- Old= ? w reduced ?
- Reduced ?–> gait is ? to try and ?
- ? is unaffected, though the ? is reduced
- Old= slower gait w reduced stride length
- Reduced hip flexion/extension–> gait is wide based to try and compensate for lack of stability
- Cadence (the number of full cycles in a given time) is unaffected, though the distance travelled in that time (gait speed) is reduced
7 things which happen to the eyes with age?
Steady deterioration in ?
More ? of ?
Pupil becomes ?
The ? becomes ?
? to changes in ?
Reduced sensitivity of ?
? sightedness
Steady deterioration in static acuity
More pronounced loss of dynamic visual acuity
Pupil becomes rigid & less elastic
The lens becomes opaque
Slower reaction to changes in lighting
Reduced sensitivity of colour contrast
Long sightedness
As mentioned, co-morbidities also affect the chance of falls.
Which comorbidities affect gait VS vision?
Gait - SPANVN
Visual - CGMRS
Balance/Gait:
- Stroke
- Parkinsonism
- Arthritis
- Neuropathy
- Vestibular disease
- Neuromuscular disorders
Visual Impairment:
- Cataracts
- Glaucoma
- Macular degeneration
- Retinopathy
- stroke
As mentioned, co-morbidities also affect the chance of falls.
Which comorbidities affect cognition and CVS? What are other comorbidities which can cause falls?
Cognition: Dementia, Delirium
Cardiovascular:
Carotid sinus syncope
Arrhythmias
Neurocardiogenic syncope
Orthostatic hypotension
Post prandial hypotension
Valvular heart disease
Incontinence (rushing to the toilet rather than focusing on walking)
Anaemia
Certain medications can also contribute to falls. Which medication should you be aware of?
Which extrinsic factors contribute to falls?
What kind of assessment can help reduce risk of falls?
Lighting (affects vision)
Rails (absence can limit support)
Rugs/carpets, clothing, footwear (trip hazards)
Headroom and clearance (low doorframes can cause falls as pt hits head or loses balance ducking under)
Mobility aids (inappropriate aids make walking more dangerous for a patient)
OT assessment of patient’s homes can help reduce the risk of a fall-related injury
J be aware of the ss, dont memorise
Consequences of Falls
Psychological
Secondary complications
Morbidity and mortality
describe multifactorial risk assessment to reduce the chance of falls?
Compare the role of physio vs OTs in preventing falls
Hip and fragility fractures are 2 severe consequences of falls. Describe these
What are the most common fragility fractures?
A hip fracture=a break in the upper ¼ or proximal part of the femur
Fragility fractures occur as a result of normal activities (fall from standing height).
They are low impact– i.e. they result from an impact that would not cause a fracture in younger adults
Colles’ fractures of the radius, vertebral fractures and hip fractures are the most common fragility fractures
What is the initial management of a hip fracture?
What is the medical and surgical management of a fracture?
.
What are 2 types of hip fracture?
Label the different fracture points on this diagram
Outline the surgical interventions for each type of fracture
Intracapsular: Hemiarthroplasty, Total hip replacement, Cannulated screws
Trochanteric: Dynamic hip screw
Subtrochanteric: Intermedullary nail
What is the MDT post op management for a surgical fracture?
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