Falls Flashcards
(21 cards)
What is the definition of a fall?
An unexpected event in which the participant comes to rest on the ground, floor or lower level.
Prevalence of falls increases with age. True/false?
True
30% of over 65s
42% of over 75s
50% of over 80s fall at least once a year.
What complications can result due to a fall?
Lead to functional decline, social isolation, loss of confidence, morbidity and mortality.
Why are older people more likely to experience falls?
Vision: smaller pupils, lens thickening = less light in to eye
Sarcopenia: loss of muscle mass and function
Decreased cardiorespiratory fitness
Decreased peripheral sensation and proprioception leading to increased postural sway
Central processing and cognition: decreased reaction time
Intrinsic factors leading to falls?
Age-related changes in gait, postural reflexes, muscle strength etc
Medical conditions
Cognition
Impaired vision and hearing
Intrinsic factors leading to falls (medical conditions)?
Diabetes mellitus → diabetic neuropathy →altered proprioception + poor vision
Arthritis, Parkinson’s, Stroke → altered gait pattern
Incontinence → increased need to rush, mobilising at night etc
Acute illness (almost anything)
Extrinsic factors leading to falls?
Medications such as diuretics, anti-hypertensives, sedatives, anti-cholinergics, hypoglycaemic agents.
Environmental – rugs, furniture, stairs etc
Inadequate lighting – falls at night
Inappropriate footwear
Inappropriate use of walking aids
What is the annual incidence of falls in people with cognitive impairment?
70-85%
What can decrease risk/rate of falls?
Early cataract surgery
Bifocal and varifocal glasses are associated with increased falls risk.
How many medications must the patient be on to be considered a falls risk?
4 or more
However the more medications the patient is on, the greater the risk
What drug groups can increase the risk of falls?
Psychotropic drugs
Taking such a medicine roughly doubles the risk of falling.
Remember some antidepressants and antipsychotics also cause orthostatic hypotension (e.g. venlafaxine, duloxetine, risperidone, haloperidol)
Phenytoin may cause permanent cerebellar damage and unsteadiness in long term use at therapeutic dose. Excess blood levels cause unsteadiness and ataxia.
What blood pressure in people of older age increases fall risk?
In older people a systolic BP of 120mmHg or below is associated with an increased risk of falls.
What % of people over 80 have gait disturbances?
Around 62% - whether from neurological or non-neurological causes such as osteoarthritis
For older people with gait disturbances, what is to be examined in the lower limb?
Always examine the lower limbs for:
Joint swelling or muscle atrophy
Shortening/Foot drop from previous injury
Peripheral neuropathy
Abnormalities of the feet or inappropriate footwear.
Romberg’s test – positive in both proprioceptive and vestibular disorders.
What is the most common neurological cause of ataxia in the elderly, resulting in impairments in distal proprioception and strength.
Peripheral neuropathy
What features can indicate functionally significant peripheral neuropathy?
loss of heel reflexes
decreased vibratory sense that improves proximally
impaired position sense at the great toe
inability to maintain unipedal stance for 10 seconds in three attempts.
How is orthostatic hypotension confirmed and tested?
Diagnosis based largely on typical history of postural symptoms.
Confirmed by lying/standing blood pressure testing:
- Measuring blood pressure and pulse rate when lying down and standing up
- Doing blood tests to check thyroid and sugar levels
- Doing an electrocardiogram (ECG) to check heart rhythm
What are the causes of orthostatic hypotension?
Baroreflex dysfunction – loss of baroceptor sensitivity and vasoconstriction associated with ageing (and vascular disease).
Triggered by medications or other circumstances (e.g., volume depletion, physical deconditioning due to prolonged bed rest).
Many diseases that cause peripheral neuropathy (most notably diabetes mellitus and amyloidosis) can produce autonomic neuropathy and neurogenic orthostatic hypotension.
Patients with Parkinson’s disease and Lewy body dementia frequently suffer neurogenic orthostatic hypotension of varying severity.
What is the management of orthostatic hypotension?
Stop culprit drugs – diuretics, anti-hypertensives, dopamine agonists, pregabalin, review anti-depressants
Encourage patient to avoid sudden changes in movements.
‘Water loading’
Increase salt in diet
Compression stockings
Keep legs elevated when sitting/sleeping.
Calf muscle exercises when standing for prolonged periods
For orthostatic hypotension, what is the medical management if conservative management proves ineffective?
Only when conservative measurements have failed then consider medication – fludrocortisone, midodrine
When orthostatic hypotension is not detected during the posture test and the patient gives a history suggestive of orthostatic hypotension. What test can be used?
Tilt-table test
Records blood pressure, heart rhythm and heart rate on a beat-by-beat basis as the table is tilted to different angles. The table always stays head-up.
