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Geriatrics COPY COPY > Balance and Falls > Flashcards

Balance and Falls Flashcards

1
Q

What are risk factors for falls (STEADI)?

A
  1. Lower body weakness
  2. Vitamin D deficiency
  3. Difficulties with walking and balance
  4. Use of medicines, such as tranquilizers, sedatives, or antidepressants
  5. Vision problems
  6. Foot pain or poor footwear
  7. Home hazards or dangers such as broken or uneven steps, and throw rugs or clutter that can be tripped over
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2
Q

What are extrinsic risk factors for falls?

A
  1. Hazardous activities
  2. Time of day
  3. External lighting
  4. Clutter
  5. Spills
  6. Loose electrical cords
  7. Footwear
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3
Q

What are intrinsic risk factors for falls?

A
  1. Age > 80 years
  2. History of falls (>/=2)
  3. Cognitive impairment
  4. Perceived poor health
  5. Depression
  6. Visual deficit(s)
  7. Impaired ADLs
  8. Gait deficit
  9. Balance deficit - Feeling unsteady
  10. Decreased Activity Level
  11. Use of assistive device
  12. Arthritis
  13. Muscle weakness
  14. ROM deficits
  15. Medications
  16. Neurologic deficits
  17. Cardiovascular deficits - bradycardia, orthostatic hypotension, and carotid sinus syndrome
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4
Q

What medications increase fall risk?

A
  1. Meds Anti-hypertensives
  2. Anti-depressants
  3. Levodopa
  4. Antipsychotics
  5. Any sedative drugs including some muscle relaxants
  6. Long-term steroids – proximal muscle weakness
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5
Q

What are the two contractors that result in falls? why?

A
  1. Limited DF/ tight PF (#1)- ankle balance strategy lost
  2. 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
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6
Q

Whta re the overall risk factors for falls in the elderly?

A
  1. Age - >60 and >80
  2. Mental Status - Altered cognition, including confusion
  3. History of Falls - 16 to 17% of patients who have fallen will fall again
  4. Medications: Especially CNS depressants
  5. Mobility (including deficits with muscle strength, gait, balance and coordination)
  6. Toileting frequency and/or urgency*
  7. Environmental factors:
  8. Nutrition - dietary insufficiency impairs muscle function; Vitamin D combined with Calcium supplement, client’s physical function increases and risk of falls is decreased
  9. Sleep: residents who napped >30 min, or reported <6 hours sleep at night, 3x’s more likely to suffer multiple falls
  10. Musculoskeletal Pain - persons who had 2 or more pain sites, and those in the highest quartiles of pain severity and pain interference with activities
  11. Knee Replacement Surgery: 45% of the with 12 mo. post surgery
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7
Q

What are the screening questions to ask?

A
  1. Have you had a fall in the last year?

2. How do you feel about your balance (i.e., confidence)?

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8
Q

what is a positive finding for a fall risk screen?

A

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.

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9
Q

What scores indicate risk for falling on the:

  • Berg
  • Tinetti
  • SLS
A
  • Berg <45, proposed cutoff of 40
  • Tinetti <22
  • SLS <5s
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10
Q

When should you determine if you should test a patient when they’re fatigued vs non-fatigued?

A

If falls are happening during fatigue times, then assess as such

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11
Q 
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?
A 
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.

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12
Q

What is WNL for frail elderly or individuals with a disability on the TUG? What time indicates impaired functional mobility

A

11-20 WNL for frail elderly or individuals with a disability

>20 sec. = impaired functional mobility

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13
Q

What is the cut off score for the 4 square step test?

A

> 15s = at risk for multiple falls

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14
Q

What is a positive test for Romberg? Normal time?

A

Excessive sway, loss of balance, or stepping during this test is abnormal
Normal is 60s

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15
Q

What is the normal time for sharpened Romberg?

A

38s

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16
Q

What is the normal time for SLS?

A

Normal 20s

- Positive: Trunk moves >45degrees , raised foot returned to floor, arms uncrossed

17
Q

What is the normal time for one STS? cut off score for 10x STS?

A
  • One time STS norm = 1.8s
  • Nonfallers: < 20 sec. Fallers: > 28 sec.

no use of armrests!

18
Q

What is a score on the FES that indicates fear of falling?

A

<8

  • 8+ indicates lack of fear
  • scored 0-10, 0 = not confident, 10 = completely confident. total possible score is 140
19
Q

Is the Berg enough to use for balance assessment?

A

No, not adequate in predicting fall risk among older adults

- does not have high sensitivity or specificity for specific conditions

20
Q

What is the best intervention for balance?

A

Balance exercises

- getter to mix in strength too

21
Q

What does the evidence say for prevention of falls on exercise, multifactorial intervention, and environmental changes/ vita?

A
  • 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
22
Q

What are recommendations about how challenging a balance exercise is for intervention?

A

Exercise must provide a moderate (2/3 criteria) or high (3/3 criteria) challenge to balance

23
Q

What are the 3 criteria in which you can challenge balance?

A
  1. 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)
  2. 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)
  3. 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)
24
Q

What is the sufficient dose for exercise to improve balance?

A

at least 50 hours, 2 hours/wk for 6 months

25
Q

Why is ongoing exercise necessary?

A

once stopped, benefits will be lost

26
Q

Should you include a walking program for those receiving balance intervention?

A

Walking training may be included in addition to balance training but high risk individuals should not be prescribed brisk walking programs
- Not at the expense of balance training

27
Q

Should strength training be included I those receiving balance intervention?

A

strength remaining may be effective

- not crucial for balance, but many other benefits

28
Q

What are gait deviations seen in people who have a history of falling?

A
  1. reduced push-off
  2. shorter stride length
  3. higher stride frequency
  4. greater variability in their gait patterns (especially at higher speeds)
29
Q

What does tai chi do for falls?

A
  1. Decrease # falls
  2. Decrease fall risk
  3. Decrease fear
  4. Increase balance and physical performance
    - Tai Chi versus Stretching = Sustained 6 months
30
Q

What makes the standards that all hospitals have to abide my?

A

The Joint Commission (JCAHO)

31
Q

What are the 4 elements JCAHO has implemented as part of their goal to reduce falls in acute care?

A
  1. Assess the patient’s or resident’s risk for falls.
  2. Implement interventions to reduce falls based on the patient’s or resident’s assessed risk.
  3. Educate staff on the fall reduction program in time frames determined by the organization. Educate the patient or resident and, as needed, the family on any individualized fall reduction strategies.
  4. Evaluate the effectiveness of all fall reduction activities, including assessment, interventions, and education.
32
Q

What are fall risk assessments used in acute care?

A

VA falls toolkit

Morse Scale

33
Q

What are JCAHO recommendations for patients at risk of falling?

A
  1. Communicate risk to all staff, the patient, and the patient’s family
  2. Multi-pronged prevention strategies are more effective than any single intervention. 

34
Q

What are technologies used to prevent falls in acute care?

A
  1. Bed and/or chair alarms.
  2. Alarms at exits.
  3. Nurse call systems and communication systems.
  4. Low beds for patients at risk for falls.
  5. Video camera surveillance.
  6. Falls and Bedrails - Emphasize bedrail reduction; Contribute to patient fall risk by creating barriers to patient transfer; Individualize use; Alternatives
35
Q

What is the mode of intervention of institutionalized setting?

A
  1. Functional balance training
  2. High intensity strength training
  3. Gait Training
  4. Power training supervised
36
Q

What is the dose of intervention of institutionalized setting?

A

Minimum of 8 weeks, max 1 year

- frequency duration: consistent, structured progressions, and individualized

37
Q

Evidence on fall prevention: A ______ falls prevention program reduces the incidence of falls in the subacute hospital setting.
The use of a ________ in hospital units compared with usual care significantly reduced rate of falls.

A

targeted multiple intervention; fall prevention tool kit

Geriatrics COPY COPY (12 decks)

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