Fall Prevention and Management

Question 1

What is Ageing?

Answer 1

Accumulation of molecular and cellular damage over time. Degenerative process.

Question 2

What are the consequences of Ageing? (8)

Answer 2

• ↓ reaction time
• Gait impairment
• ↓ adaptive strategies
• Balance impairment
• Difficulties in double tasks
• ↓ perception of obstacles and adaptation to light
• Sarcopenia
• Hormonal changes (sleep, osteoporosis)

Question 3

Sarcopenia - Cause (7)

Answer 3

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.

Question 4

Frailty - 4 Major Components

Answer 4

Muscle function
Balance and walking function
Cognitive function
Nutritional status

Question 5

Frailty - 5 Areas

Answer 5

Mobility
Physical impairments
Sensory ability (hearing, seeing)
Memory (cognitive dysfunction)
Energy (fatigue)

Question 6

Falling - Definition

Answer 6

An event in which a person inadvertently lands on the ground or other surface at a lower level than previously.

Question 7

Falling - Consequences (4)

Answer 7

Significant and lasting functional decline.
↑ mortality risk
Fracture of hip and vertebra -> ↑ mortality
10% result in fractures, 10% result in medical interventions.

Question 8

Post Fall Syndrome

Answer 8

Fear of falling (may predate the fall)
Psychomotor maladjustment:
- Spontaneous reduction in activity
- ↓ functional abilities
- Postural disorders
- ↑ risk of further falls

Question 9

Predictive Factors (5)

Answer 9

Ageing
Medication
Pathology affecting equilibrium function
Environment
Behavior

Question 10

Extrinsic Factors (3+6)

Answer 10

• Behavioral (alcohol, nutrition, sedentary lifestyle)
• Risk taking
• Environmental (object on ground, poor lighting, slippery/uneven ground, steps, chair and bed height (lower))

Question 11

Intrinsic Factors (8)

Answer 11

• > 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.

Question 12

Recurrence Factors (7)

Answer 12

• 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)

Question 13

Prevention Interventions (4)

Answer 13

If risk factors are present after assessment.
Personalized multifactorial intervention:
- Exercise prescription: gait and balance
- Medication prescription adaptation
- Intrinsic risk factor adaptations
- Environmental adaptations

Question 14

Assessing Frailty - Fred’s Criteria (5)

Answer 14

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

Question 15

Frailty - What to Assess? (5)

Answer 15

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).

Question 16

Fall Management in Elderly - Role of Physio + Goals (4)

Answer 16

Work in an interdisciplinary team and investigate possible causes of falls.
- Prevent future falls by ensuring safe living environment.
- Prevent future falls by working on mobility, balance and strength.
- Restore confidence to improve QoL and reduce FoF.
- Training patients to cope with future falls and minimize complications.

Question 17

Fall Management in Elderly - Interventions (4)

Answer 17

• Correction of deficiencies/accessories (visual impairments, shoes and hip protectors)
• Housing (floor mats, slippery floor, bad lighting, stairs, furniture height)
• General Guidelines for PA (150 min mod. activity / week, 2x strengthening / week)
• Addressing fear (progressive exposure, desensitization process)