Balance and Falls Flashcards
(37 cards)
What are risk factors for falls (STEADI)?
- Lower body weakness
- Vitamin D deficiency
- Difficulties with walking and balance
- Use of medicines, such as tranquilizers, sedatives, or antidepressants
- Vision problems
- Foot pain or poor footwear
- Home hazards or dangers such as broken or uneven steps, and throw rugs or clutter that can be tripped over
What are extrinsic risk factors for falls?
- Hazardous activities
- Time of day
- External lighting
- Clutter
- Spills
- Loose electrical cords
- Footwear
What are intrinsic risk factors for falls?
- Age > 80 years
- History of falls (>/=2)
- Cognitive impairment
- Perceived poor health
- Depression
- Visual deficit(s)
- Impaired ADLs
- Gait deficit
- Balance deficit - Feeling unsteady
- Decreased Activity Level
- Use of assistive device
- Arthritis
- Muscle weakness
- ROM deficits
- Medications
- Neurologic deficits
- Cardiovascular deficits - bradycardia, orthostatic hypotension, and carotid sinus syndrome
What medications increase fall risk?
- Meds Anti-hypertensives
- Anti-depressants
- Levodopa
- Antipsychotics
- Any sedative drugs including some muscle relaxants
- Long-term steroids – proximal muscle weakness
What are the two contractors that result in falls? why?
- Limited DF/ tight PF (#1)- ankle balance strategy lost
- Knee flexion contracture - Changes COM
- Weakness around the knee and ankle relate to increased incidence of falls; Ankle DF strength more highly correlated with fallers than knee or ankle PF’s
Whta re the overall risk factors for falls in the elderly?
- Age - >60 and >80
- Mental Status - Altered cognition, including confusion
- History of Falls - 16 to 17% of patients who have fallen will fall again
- Medications: Especially CNS depressants
- Mobility (including deficits with muscle strength, gait, balance and coordination)
- Toileting frequency and/or urgency*
- Environmental factors:
- Nutrition - dietary insufficiency impairs muscle function; Vitamin D combined with Calcium supplement, client’s physical function increases and risk of falls is decreased
- Sleep: residents who napped >30 min, or reported <6 hours sleep at night, 3x’s more likely to suffer multiple falls
- Musculoskeletal Pain - persons who had 2 or more pain sites, and those in the highest quartiles of pain severity and pain interference with activities
- Knee Replacement Surgery: 45% of the with 12 mo. post surgery
What are the screening questions to ask?
- Have you had a fall in the last year?
2. How do you feel about your balance (i.e., confidence)?
what is a positive finding for a fall risk screen?
The patient reports multiple falls regardless of balance and gait impairments
OR
The patient reports one fall, and a balance or gait impairment is observed or patient feels unconfident.
What scores indicate risk for falling on the:
- Berg
- Tinetti
- SLS
- Berg <45, proposed cutoff of 40
- Tinetti <22
- SLS <5s
When should you determine if you should test a patient when they’re fatigued vs non-fatigued?
If falls are happening during fatigue times, then assess as such
What are the norms for the functions reach test for the following age groups: 20-40 41-69 70-87 What is the cut off score?
20-40 = 14-17 inches 41-69 = 13-16 inches 70-87 = 10-13 inches
<7 may indicate frail individual who is limited in mobility and ADL skills and demonstrates increased fall risk.
What is WNL for frail elderly or individuals with a disability on the TUG? What time indicates impaired functional mobility
11-20 WNL for frail elderly or individuals with a disability
>20 sec. = impaired functional mobility
What is the cut off score for the 4 square step test?
> 15s = at risk for multiple falls
What is a positive test for Romberg? Normal time?
Excessive sway, loss of balance, or stepping during this test is abnormal
Normal is 60s
What is the normal time for sharpened Romberg?
38s
What is the normal time for SLS?
Normal 20s
- Positive: Trunk moves >45degrees , raised foot returned to floor, arms uncrossed
What is the normal time for one STS? cut off score for 10x STS?
- One time STS norm = 1.8s
- Nonfallers: < 20 sec. Fallers: > 28 sec.
no use of armrests!
What is a score on the FES that indicates fear of falling?
<8
- 8+ indicates lack of fear
- scored 0-10, 0 = not confident, 10 = completely confident. total possible score is 140
Is the Berg enough to use for balance assessment?
No, not adequate in predicting fall risk among older adults
- does not have high sensitivity or specificity for specific conditions
What is the best intervention for balance?
Balance exercises
- getter to mix in strength too
What does the evidence say for prevention of falls on exercise, multifactorial intervention, and environmental changes/ vita?
- Exercise = Consistent Moderate to High Quality Evidence; doesn’t seem to make a difference if it was home, community, or tai chi
- Multifactorial Intervention = Moderate to High Quality Meta Analysis
- Environmental Changes and Vitamin D = Conflicting Evidence
What are recommendations about how challenging a balance exercise is for intervention?
Exercise must provide a moderate (2/3 criteria) or high (3/3 criteria) challenge to balance
What are the 3 criteria in which you can challenge balance?
- Reducing the base of support (e.g. standing with both legs close together, standing with one foot directly in front of the other, i.e. a tandem stance position and, if possible, standing on one leg)
- Movement of the centre of gravity – control of the body’s position while standing (e.g. reaching safely, transferring the body weight from one leg to the other, stepping up onto a block)
- Reducing the need for upper limb support with exercises in standing that do not use the arms for support. If this is not possible the aim should be to decrease reliance on the arms (e.g. hold onto a bar with one hand instead of both hands, rest one finger on a table rather than the whole hand)
What is the sufficient dose for exercise to improve balance?
at least 50 hours, 2 hours/wk for 6 months
