Falls Flashcards
(27 cards)
Reasons for older people at an increased risk of falls
- Impaired balance or gait - sense of balance goes
- Mobility problems e.g. arthritis, motor diseases such as PD
- Muscle weakness
- Visual impairment
- Impaired cognition e.g. dementia, visual perceptions
- Home hazards (unsuitable footwear, rugs, pets)
- Postural hypotension
- Taking 4 or more medications
Infection
What are the consequences of falls?
- Fractures of the hip, femur, humerus, wrist and rib
- Soft tissue injuries
- Haematoma
- Transient confusion
- Loss of confidence, independence or social and physical activity
- Sudden ageing
- Hospitalisation and immobilisation
- Disability
Death
What are the two classes of drugs that have the highest possibility to cause falls?
1) Drugs acting on the brain (psychotropic drugs)
2) Drugs that act on the heart and circulation
What types of drugs act on the brain and can cause falls?
Sedatives, antipsychotics, and sedating antidepressants cause drowsiness and slow reaction times.
What effect can some antidepressants and antipsychotics have on blood pressure?
They can cause orthostatic hypotension.
What systolic blood pressure level in older people is associated with an increased risk of falls?
A systolic BP of 110mmHg or below.
What types of drugs can cause falls related to heart and circulation?
Any drug that reduces BP or slows the heart can cause falls, fainting, or loss of consciousness.
What can stopping cardiovascular disease (CVD) medication do?
It reduces syncope and falls by 50%.
What may indicate a clear cause of falls in some patients?
They may be hypotensive or have a systolic drop on standing.
What conditions might cause syncope or pre-syncope in patients with normal BP?
Carotid sinus hypersensitivity or vasovagal syndrome.
What medication is classified as HIGH risk?
Diazepam, Zopiclone, Oxybutynin, Amitriptyline, Ropinirole, Tramadol
What medication is classified as MODERATE risk?
Citalopram, Gabapentin, Baclofen, Bendroflumethiazide, Amlodipine, Diltiazem
What medication is classified as LOWER risk in combination?
Omeprazole, Chlorphenamine, Pregabalin, Donepezil, Prochlorperazine
What is the first step in Falls Assessment?
Identify individual risk factors with a plan to address each of them.
What should be identified regarding Osteoporosis in Falls Assessment?
Identify Osteoporosis risk factors and decide if further tests (DEXA) or treatment are needed.
What options are available for improving balance?
Balance course or home exercise programme.
What is postural hypotension?
Fall of 20 mmHg in SBP or 10 mmHg in DBP on assuming upright position
What is the prevalence of postural hypotension in individuals over 75 years of age?
30%
What is a significant health risk associated with postural hypotension?
Increased all-cause mortality
What is impaired in individuals with postural hypotension?
Capacity to increase vascular resistance on standing
Is postural hypotension treatable?
Mostly treatable but easily missed
What are common symptoms of postural hypotension?
Postural dizziness or pre-syncope, falls, syncope, visual disturbance
What are other symptoms associated with postural hypotension?
Weakness, lethargy, ‘Coathanger’ ache
What are some medication causes of postural hypotension?
Anti-hypertensives - especially diuretics and doxazosin, TCA’s, PD meds, anti-psychotics
