Fall Prevention and Management Flashcards
What is Ageing?
Accumulation of molecular and cellular damage over time. Degenerative process.
What are the consequences of Ageing? (8)
- ↓ reaction time
- Gait impairment
- ↓ adaptive strategies
- Balance impairment
- Difficulties in double tasks
- ↓ perception of obstacles and adaptation to light
- Sarcopenia
- Hormonal changes (sleep, osteoporosis)
Sarcopenia - Cause (7)
Poor diet
Physical inactivity
Genetics
Comorbidities (>2 diseases at the same time)
Hormones (affected by PA)
Trauma
Neuromuscular dysfunction
Strictly correlated with physical impairment, QoL and death.
Frailty - 4 Major Components
Muscle function
Balance and walking function
Cognitive function
Nutritional status
Frailty - 5 Areas
Mobility
Physical impairments
Sensory ability (hearing, seeing)
Memory (cognitive dysfunction)
Energy (fatigue)
Falling - Definition
An event in which a person inadvertently lands on the ground or other surface at a lower level than previously.
Falling - Consequences (4)
Significant and lasting functional decline.
↑ mortality risk
Fracture of hip and vertebra -> ↑ mortality
10% result in fractures, 10% result in medical interventions.
Post Fall Syndrome
Fear of falling (may predate the fall)
Psychomotor maladjustment:
- Spontaneous reduction in activity
- ↓ functional abilities
- Postural disorders
- ↑ risk of further falls
Predictive Factors (5)
Ageing
Medication
Pathology affecting equilibrium function
Environment
Behavior
Extrinsic Factors (3+6)
- Behavioral (alcohol, nutrition, sedentary lifestyle)
- Risk taking
- Environmental (object on ground, poor lighting, slippery/uneven ground, steps, chair and bed height (lower))
Intrinsic Factors (8)
- > 80 y.o.
- ↓ ADLs and mobility
- Parkinson’s, dementia, incontinence
- ↓ knee/hip/ankle/grip strength
- ↓ visual acuity
- Gait dysfunction, ↓ walking speed, altered dynamic balance, STS difficulty.
- MMSE, depression
- Sedative, hypnotic, anxiolytic meds, >4 meds.
Recurrence Factors (7)
- History of falls > 2x
- On the ground for > 3 hours
- Tinetti test < 20 points
- TUG > 20 seconds
- Unipodal hold < 5 seconds
- Impaired postural adaptation reactions
- Stop walking when asked to speak (dual task)
Prevention Interventions (4)
If risk factors are present after assessment.
Personalized multifactorial intervention:
- Exercise prescription: gait and balance
- Medication prescription adaptation
- Intrinsic risk factor adaptations
- Environmental adaptations
Assessing Frailty - Fred’s Criteria (5)
1) Physical inactivity: <150min mod. activity / week
2) Low muscle strength: Grip < 21kg M, <14kg W.
3) Slow walking speed: < 0,8 m/s
4) Exhaustion/fatigue: self reported
5) Weight loss: 5% in 1 year
Frailty - What to Assess? (5)
1) Muscle function: grip strength, STS
2) Balance & walking function: TUG, 6MWT, Tinetti, Unipodal balance, SPPB.
3) Cognitive function: MMSE, CODEX (dementia), Geriatric depression scale.
4) Nutritional status: Nutritional screening initiative.
5) Dependency: KATZ (ADLs), IADL (IADLs).
