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Falls Flashcards

(44 cards)

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1
Q

Usual causes of falls in the elderly?

A

Bad flooring
Bad lighting
Medications
Alcohol

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2
Q

What main 3 overarching classes of drugs can increase fall risk?

A

Psychotropic medication
Cardiovascular medication
Pain medication

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3
Q

Name 5 psychotropic medication types that can increase fall risk?

A 
Antidepressants
anxiolytics
Hypnotics
Sedatives
Anticonvulsants
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4
Q

Name 7 cardiovascular medication types that increase fall risk?

A 
Alpha blockers
Beta blockers
ACE inhibitors 
Calcium channel blockers
Diuretics
Anti hypertensives 
Nitrates
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5
Q

6 causes of fainting or LOC spontaneous falls in elderly?

A 
Vasovagal response
Blood loss
Medication
Cardiac disease
Blood complication - electrolytes, glucose, oxygen/co2, 
Intrinsic brain disease
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6
Q

What is stimulated in a vasovagal faint?

A

nucleus tractus solitarii

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7
Q

What are debility related falls described as?

A

Premonitory falls of old age

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8
Q

3 main causes of spontaneous falls in elderly?

A

LOC/fainting
Diffuse brain injury
debility

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9
Q

If the patient falls whilst moving what are 7 different causes related to different types of movement?

A

Standing up - postural hypotension
Exertion - aortic stenosis, pulmonary hypertension or pulmonary stenosis
Carotid sinus hypersensitivity
Moving the arm - subclavian steal syndrome
Coughing syncope
Micturition syncope
Turning - vertebro-basilar ischaemia

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10
Q

What locomotor disorders can cause falls in elderly?

A

OA
Parkinsons
Stroke
Peripheral neuropathy

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11
Q

Besides fainting and locomotor disorders what another big reason of falls in elderly on movement?

A

Visual impairment

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12
Q

What happens in vertebrobasilar ischaemia and what does it lead to?

A

there is reduced blood supply through the vertebral arteries which causes ischaemia of the brain stem and therefore leads to drop attacks

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13
Q

What is the main cause of recurrent drop attacks?

A

Vetebro-basiliar ischaemia

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14
Q

Why does turning the head cause vertebrobasiliar ischaemia? What is it a disease of?

A

Kinks the vertebral arteries as they pass through the foreman
Disease of the cervical vertebrae or intervertebral joints

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15
Q

What kind of physical limitation is often found in people who suffer with vertebrobasilar ischaemia?

A

Head rotation limitation

Pain on moving neck

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16
Q

4 main causes of postural hypotension?

A

antihypertensive medication, hyponatraemia caused by diuretics usually, autonomic neuropathy (diabetics), sympathectomy

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17
Q

What difference in blood pressure is needed lying to standing in order to diagnose postural hypotension?

A

20mmHg or more

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18
Q

What medication can be used to treat autonomic neuropathy related postural hypotension?

Study These Flashcards
A

Fludrocortisone - increase sodium

19
Q

What happens in cough and micturition syncope that leads to fainting?

Study These Flashcards
A

Increase in intrathoracic pressure
valsalva manouvre
drop in BP

20
Q

difference between epilepsy and syncope?

Study These Flashcards
A

Epilepsy has tonic clonic seizures, takes longer to recover from, proceded by an aura and sudden onset, no change in colour, UI, tongue biting, transient hemiplegia

21
Q

Most are 3 reasons for new onset epilepsy in the elderly?

Study These Flashcards
A

Cerebrovascular disease
Dementia
Tumours

22
Q

How can you investigate and establish whether someone has epilepsy or syncope?

23
Q

What is Todd’s paralysis?

Study These Flashcards
A

After a seizure can experience focal weakness in a part of the body after a seizure, appendages most effected, localised

24
Q

What is carotid sinus hypersensitivity?

Study These Flashcards
A

Sensitivity of the carotid sinus baroreceptors that leads to transient diminished cerebral perfusion

25
How do you diagnose carotid sinus hypersensitivity and what 2 things does a positive result show?
Carotid sinus massage Cardio inhibition - 3 seconds asystole Vasodepression - BP drops by 50mmHg Combination
26
4 things that carotid sinus hypersensitivity is associated with?
Hypertension IHD Lewy body dementia Medications
27
If someone complains of dizziness what 2 things do you need to distinguish between?
Whether the dizziness is caused by vertigo or if it is light headedness caused by issues in multiple sensory inputs
28
How long does BPPV attack last for?
around 30 seconds
29
What are the crystals called that get dislodged in BPPV?
otoliths
30
2 situations where someone is more predisposed to developing BPPV?
Previous head trauma or vestibular necrosis
31
What is the test for BPPV and what is the treatment?
Dix hallpike test | Epley Manoeuvre
32
What is considered a long lie after a fall?
over 2 hours
33
With a long lie after a fall what are 6 risk factors that could potentially develop?
``` dehydration pneumonia pressure sores rhabdomyolysis hypothermia delirium ```
34
When taking a history of a fall what 12 things do you need to ask about in the history?
``` Cognition Gait and balance Sensory loss Sleep Continence Footwear and footcare Osteoporosis risk factors Dizziness/syncope Medication Previous falls and injury SH Assess home hazards ```
35
How do you assess gait and balance?
``` length of step and foot lifting Use of walking aids? Speed of walking Time up and go BERG balance test ```
36
What is the BERG balance test?
It is a 56 point scoring system with 14 activities rated 0-4 on ability to complete them
37
3 steps in management of a fall in the elderly?
Fix the injury rehabilitation Falls service
38
What do the Falls service do?
They provide education on falls Prevent repeat falls Bone health
39
7 ways we can prevent falls in the elderly?
``` Education (Falls service) Review medications Provide better lighting Alarms regular eye checks Elastic stockings for those with varicose veins or leg oedema Footwear ```
40
Parkinson like symptoms that are often common in the elderly? 3 differentials?
Rigidity Apraxia of gait Wide based gait Poverty of movement Increased muscle tone - cogwheel character Differentials include ministrokes, normal pressure hydrocephalus, dementia
41
what is normal pressure hydrocephalus and what are the triad of symptoms?
When there is abnormal levels of CSF production causing ventriculomegaly but adapts to a higher normal of 150 to 200 mm H20 ICP isnt elevated Symptoms arent classic triad- UI, mental impairment, walking difficulties
42
What is the gait usually like in normal pressure hydrocephalus?
Apraxic gait Spasticity Bilateral extensor plantar responses
43
How do you diagnosis normal pressure hydrocephalus?
CT Dilated ventricles ICP is usually normal
44
Treatment of normal pressure hydocephalus?
Ventriculoperitoneal shunt or ventriculoatrial shunt | Rehabilitation

Geriatrics (10 decks)

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