Falls Flashcards
(30 cards)
Falls or Motor Vehicle Crash (MVC) – Which is the most common cause of traumatic brain injury (TBI)
Falls
•Fall or MVC – Which is the most common cause of injury-related death in older adults?
Falls
Consequences of falls in the elderly
____% result in serious injuries
_____% cause fracture
_____ residents die each year from falls.
- 10-20% result in serious injuries
- 2-6% cause fractures
- 1800 residents die each year from falls
- Disability and functional decline
- Reduced quality of life
- Feelings of helplessness
- Depression
- Social isolation
after age 65
_ in _ older adults fall each year
_____ is leading cause of death
_____% moderate to severe injuries
- 1 in 3 older adults falls each year
- Falls are the leading cause of injury death in older adults
- 1 in 3 older adults falls each year
- 20% -30% - moderate to severe injuries
- Risk of injury or death ↑s with age
Nursing homes
- What % of older adults live in nursing home?
- How many % of fall death occur in this group?
- How many bed nursing home reports ___ falls?
- Nursing home has ____x the fall rate of community dwellers
- Average of ____falls per person per year.
- 4 - 5 % of older adults live in nursing homes
- 20% of all fall deaths occur in this group
- Every year: typical 100-bed nursing home reports 100 – 200 falls
- Many are unreported
- 2 x the fall rate of community dwellers
- Average of 2.6 falls per person per year
- 35% of injuries: persons who cannot walk
How does number of falls relate to number or risk factors?
More number of risk - increases falls.
2+ falls in 1 year
0-1 risk = 10% with 2+ falls
4+ risk = 69% with 2+ falls
High Risk Time Periods for Falls
- First month after hospital discharge
- During an acute illness
- During an exacerbation of a chronic illness
- Recent eye surgery or procedure
Common causes for falls
*exam
- 1/3 - Intrinsic risk factors (medical and age-related factors)
- 1/3 - Medications, alcohol use and OTC products
- 1/3 - Extrinsic risk factors (environmental)
Name intrinsic risk factors, extrinsic risk factors, and precipitating causes that lead to falls
*exam
Extrinsic Factors:
- Enviromental hazards
- poor footwear
- restraints
Precipatiating factors:
trips+slips, drop attack, syncope, dizziness, acute medical issues
Intrinsic risk factors:
- gait and balance impairment
- Peripheral neuropathy
- vestibular dysfunction
- muscle weakness
- vision impairment
- medical illness
- advanced age
- impaired ADL
- orthostatic hypotension
- dementia
- drugs
Medications associated with falls
6 categories.
***Exam
- •Anticholinergics – consider total anticholingeric load
- •Neuropsychiatric – benzodiazepines, neuroleptics, antidepressants, anticonvulsants, antiparkinson, muscle relaxants, analgesics
- •Cardiovascular – antihypertensives, antiarrythmics (type 1 A), digoxin, nitrates
- •Alcohol
- •Histamine (H2) blockers – cimetidine
- •Over-the-Counter – cough / cold remedies, sedatives, antihistamines
Which of the following CNS medications has been associated with the largest increase in Falls ?
- Benzodiazepines (short and long acting)
- Antidepressants-SSRI
- Antidepressants-Tricyclics
- Anticonvulsants
- Narcotics
- Benzodiazepines (short and long acting)
Describe Clinical Approach to Falls
- NOT WHAT DISEASE caused the problem? (Based on one disease/diagnosis model)
- BUT WHAT COMBINATION of Physiologic changes, impairments and diseases are contributing?
- AND WHICH ONES can be modified? (Multifactorial Impairment and Intervention Model)
Fall Mnemonic: SPLATT
assessment of falls
S Symptoms
P Previous falls
L Location
A Activity
T Time: time of day or night
T Trauma
Fall Assessment
Important Details of events surrounding the fall:
- What was the patient doing when he/she fell?
- Was there an aura?
- Was there a loss of vision?
- Did the patient experience any dizziness?
- Was there a loss of consciousness?
- In what direction did the patient fall?
- Did the patient break the fall?
- Was he or she using any assistive devices appropriately?
- Did witnesses notice any seizure activity?
Determine whether falls recurrent or whether they recently increased.
Describe the PE for assessing falls
- Comprehensive with focus on:
- Orthostatic: BP and pulse
- CV: arrhythmia, murmurs, carotid bruits
- Sensory: visual or hearing impairments
- Musculoskeletal: arthritic changes, limitations in joint motion, deformities, fractures, foot problem, strength of lower extremities
- Neurologic: nystagmus, neuropathy, tremors, rigidity, focal deficits, weakness
- Cognitive status: Mini-cog, MMSE
- Mood: GDS
Describe the Timed ‘Up and Go’ test
Sensitivity and Specificity
*exam
- Simple test of observing a person stand up from a chair, walk 10 feet, turn around, walk back, and sit down again.
- Correlates with ADLs
- Normal person takes
- Note: use of hands, staggering, unsteadiness
- Sensitivity, 54-87%; Specificity 74-87%
Fall: Diagnostic Studies
*exam
- Based on the presenting symptoms and the anticipated benefits for the individual patient.
- CBC: rules out anemia or infection
- Urinalysis: rules out infection
- CMP: rules out electrolyte imbalance
- TSH
- Vitamin B12
- ESR
- Drug levels as indicated
- ECG
- Chest X-ray
- Holter monitor: if transient arrhythmia is suspected
- Head CT scan: if mental status or neurologic changes are present
Fall Mnemonic: I HATE FALLING
assessment of falls
*Exam
I Inflammation of joints (or joint deformity)
H Hypotension (orthostatic blood pressure changes)
A Auditory and visual abnormalities
T Tremor (Parkinson’s disease or other causes of tremor)
E Equilibrium (balance) problem
F Foot problems
A Arrhythmia, heart block or valvular disease
L Leg-length discrepancy
L Lack of conditioning (generalized weakness)
I Illness
N Nutrition (poor; weight loss)
G Gait disturbance
What % of falls can be prevented?
30-40%
algorithm for falls screening
initial question
- 2+ fall in past year?
- presents with acute fall?
- diffculty balance or walking?
Falls 2/2 leg extension weakness
what would you see on exam, how to manage risk?
- Impaired Get up & go, stair climbing, slow gait
- MGMT
- Resistance training
- Quadriceps sets
- Environmental Safety + Osteoporosis prevention (calcium & Vitamin D)
Falls 2/2 poor balance
what would you see on exam, how to manage risk?
- Exam:
- +Romberg
- Poor vision
- Impaired functional reach
- MGMT
- Balance training
- Widen base of support
- Shoes
- Quad cane
- Walker
- Correct vision
- Correct hearing
- Environmental Safety + Osteoporosis prevention (calcium & Vitamin D)
Falls 2/2 Medication Toxicity
what would you see on exam, how to manage risk?
- Exam: Alcohol use, anticonvulsants, digoxin, sedatives/hypnotics anticholinergics, hypotensives, nitrates, antipsychotics, antidepressants
- MGMT:
- Drug withdrawal
- Drug substitution
- Drug reduction
- Environmental Safety + Osteoporosis prevention (calcium & Vitamin D)
Falls 2/2 hypotension
what would you see on exam, how to manage risk?
- Exam: Orthostatic and postprandial hypotension
- MGMT:
- Drug reduction
- Behavior change
- Drug/meal separation
- Posture
- Meals
- Exercises
- Volume
- Salt
- Stockings
- Head of bed elevation
- Pharmacologic, eg. Fludrocortisone, midodrin
- Environmental Safety + Osteoporosis prevention (calcium & Vitamin D)
