Falls Flashcards
(17 cards)
Important risk factors for falls? (5)
Age Female gender Low weight Polypharmacy and certain medications e.g. psychotropics Dependency in ADLs Cognitive impairment
Why are falls in older people more likely to result in injury e.g. fractured NOF?
Bone pathology e.g. osteoporosis, bone mets
Poor protective mechanisms
What are some of the factors in poor self protection in falls? (4)
Lack of subcutaneous fat
Syncopal falls
Slow and stiff joints/movements
Neurological problems e.g. reflexes
Important aspects of the falls history? (7)
Pattern of the falls What was the patient doing at the time? Loss of consciousness? Warning before the fall? How did they feel after the fall? Witnessed? Last seen by optician?
Body systems which can be implicated in falls?
Visual Cardiovascular Neurological Musculoskeletal Vestibular
Ways in which eyesight may be impaired?
Reduced acuity
Reduced visual fields
Decreased dark adaptation
Underlying causes in elderly people:
a) reduced visual acuity
b) reduced visual fields
c) decreased dark adaptation
a) presbyopia; macular degeneration; cataracts
b) glaucoma, posterior circulation stroke
c) miotic agents for glaucoma
Vestibular causes of falls? (3)
BPPV
Meniere disease
Labyrinthitis
Maneuver which a) reproduces symptoms b) treats BPPV?
a) Dix-Hallpike
b) Epley
Causes of peripheral neuropathy? (3)
Diabetic neuropathy, peripheral vascular disease, vitamin B12 deficiency
Cardiac/circulatory causes of falls? (5)
Orthostatic hypotension
Aortic stenosis
Tachy or brady arrythmias
Autonomic dysfunction e.g. due to diabetes
Dehydration e.g. secondary to diuretic therapy
Neurological causes of falls?
Stroke (either old or new onset) Dementia/other cognitive impairment e.g. delirium Movement disorders e.g. PD, cerebellar Vertebrobasilar insufficiency Focal neurological deficits
Musculoskeletal causes of falls?
Muscle weakness
Loss of flexibility
Pain (muscle, joint)
Minimum investigations/procedures in falls?
- Medication review
- Standing and sitting BP
- Cardiac auscultation
- Cognitive assessment e.g. MMSE
- Full neurological exam including gait and balance
- Visual acuity
- ECG
- give consideration to bone protection and fracture risk
Important risk factors for fracture? (4)
Increasing age
Female sex
Low body mass
Corticosteroid therapy/Cushings
How is osteoporosis defined with reference to DEXA scan?
hip bone mineral density more than 2.5 standard deviations below the young adult reference mean
Secondary causes of osteoporosis?
RA and other inflammatory arthropathies
