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*Medicine: Geriatrics > Falls > Flashcards

Flashcards in Falls Deck (20)
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1

Falls are multifactorial - only 15% of falls have a single underlying medical cause. What are the most common risk factors for falls?

  • previous falls
  • impairment of balance/gait
  • visual impairment
  • cognitive impairment
  • drugs (>4 drugs)
  • fear of falling
  • urinary incontinence
  • poor foot care/footwear
  • postural hypotension
  • acute medical illness (virtually anything in the elderly)

2

How might drugs and alcohol cause falls?

  • use of >4 drugs poses a significant risk factor
  • some drugs inc propensity of falling more than others
    • antihypertensives + sedatives
  • iatrogenic falls eg due to postural hypotension (diuretics), cardiac arrhythmias (TCAs) and extrapyramidal effects (neuroleptic medications)
  • prevention should be aimed at reducing the use of unnecessary drugs
  • excessive alcohol consumption also a key risk factor for falls

3

How does vision in the elderly result in falls?

  • the eye needs double the illumination every 13 years from the age of 15 to maintain recognition in subdued lighting
  • transparency of the cornea and lens declines and corneal flattening occurs (astigmatism)
  • diameter of pupil is decreased (1mm or less commonly found in older ppl)
  • there is reduced accommodaiton
  • reduced photoreceptor number
  • presbyopia (long-sightedness caused by loss of elasticity of the lens)

4

How is the vestibular system affected by age, resulting in falls?

  • progressive reduction in hearing predominantly of higher frequency
    • due to loss of hair cells, ganglion cells + nerve fibres in cochlea
  • paralleled by a reduction in vestibular function leading to reduced balance + increased risk of falling 

5

Which aspects of the environment may pose a risk for falls?

  • lighting
  • wet floor, loose rugs
  • electrical flex
  • beds + chairs
  • cupboards
  • bathing

6

What are the neurological causes of falls?

  • visual impairment (visual acuity of 6/12 or less)
  • VIII nerve problems (labyrinthitis, BPPV)
  • epilepsy
  • stroke/TIAs
  • parkinson's disease
  • neuropathy
  • cerebellar syndromes 

7

What are the cardiovascular causes of falls?

  • hypotension (OH, MI, sudden bleed)
  • arrythmias (brady or tachy)
  • obstructive lesions (aortic stenosis, HOCM)
  • vasovagal attacks
  • carotid sinus hypersensitivity (CSH) - cardioinhibitory, vasodepressor or mixed
  • situational syncope (cough, micturition, defacation)

8

What are GI causes of falls to be considered?

  • sudden bleed
  • diarrhoea 

9

What are MSK causes of falls?

  • unstable joints
  • osteomalacia

10

What are metabolic causes of falls?

  • hypo or hyperthyroidism
  • addison's (hypotension)
  • cushing's (myopathy, hypokalaemia)
  • hypoglycaemia 

11

What are physical injury consequences of falls?

  • soft tissue bruising - may require analgesia, trauma reflected by raised CK
  • breaks in the skin - may be slow to heal + require grafting
  • fracture - orthopaedic treatment required
  • friction burns - from synthetic carpet when trying to get back up
  • falls on a hot surface may result in a burn
  • central cord lesions leading to quadriplegia in those w/ spinal cord compromised by spondylosis
  • head injuries 

12

What can prolonged periods unable to rise from the floor result in?

  • hypothermia
  • pressure sores
  • hypostatic pneumonia
  • dehydration
  • rhabdomyolysis 

13

What are psychological consequences of falling?

  • fear of falling (50%) - leads to even greater risk + social isolation
  • loss of confidence + mobility 

14

What points need to be considered when taking a falls history?

  • WHO - any witnesses, adequate collateral needed
  • WHEN - what time of day? what were they doing at time of? 
  • WHERE - in house or outside? 
  • WHAT
    • before - any warning? associated symptoms?
    • during - incontinence, tongue biting, LOC, pale, injury, contact to floor?
    • after - what happened, who got them up, how long did it take, resume normal activites, any confusion or amnesia, any weakess or speech difficulty?
  • WHY - why do you think you fell?
  • HOW - how many times fallen? gauge severity of problem
  • SYSTEMS ENQUIRY
  • PMHX 
  • SOCIAL - alcoohl, support at home, mobility 
  • MED REVIEW - polypharmacy!

15

What is the role of the physiotherapist?

  • correction prescription and use of walking aids
  • improve gait pattern (longer steps)
  • improve stability (strength + balance)
  • teach patient how to get up from the floor without help
  • individually tailored exercise plans to prevent future falls 

16

What is the role of the occupational therapist?

  • identify + remove environmental hazards
  • provide equipment to facilitate mobility at home

17

If no obvious causes of falls are found in a patient, how might you want to prevent risks and adverse consequences?

  • osteoporosis prevention w/ vit D + calcitonin or bisphosphonates
  • hip protectors
  • arrange for personally worn alarm systems
  • continual visits to the home (by carers, neighbours, family) to reduce duration of a 'lie' post-fall 
  • maintain constant environmental temperature
  • soften floor coverings 
  • remove obstacles + dangers
  • place emergency bedding where it can be reached from floor
  • give advice regarding appropriate footwear
  • reduce stressors (limiting walking to indoors, use walking stick, asking help)
  • change of accommodation 

18

Up to 50% of men presenting with vertebral or hip fractures have an underlying secondary cause of osteoporosis. What is osteoporosis?

  • skeletal disease characterised by low bone mass and micro architectural deterioration of bone tissue
  • consequent increase in bone fragility and susceptibility to fracture
  • around 50% of women and 20% of men aged 50 will have a fragility fracture in their remaining lifetime 

19

What is the most devestating consequence of osteoporosis?

  • hip fractures
  • most occur after a fall from a standing height or less
  • 90% occur in ppl 50+ 
  • 80% occur in women
  • incidence of hip fractures increases exponentially w/ age
  • lifetime risk of hip fracture for 50yr olds is 11.4% and 3.1% for women and men respectively 

20

What is the outcome in hip fracture?

  • often poor
  • 1 in 3 adults 50+ dies within 12 months of suffering hip fracture
  • cause of death is not usually directly attributable to fracture itself, but to other chronic diseases 
  • loss of physical function, decreased social engagement, increased dependence, worse quality of life