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Flashcards in Falls Deck (11)
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1

Define a fall

An event which causes a person to, unintentionally, rest on the ground or other lower level

2

List five risk factors of falls

  • Hx of falls
    • ​Critical to routinely ask older people if about falls in the past year
    • 66% risk of recurrance within a year
  • Conditions affecting mobility or balance
    • Arthritis, diabetes, incontinence, stroke, syncope, Parkinson's
  • Other conditions
    • Muscle weakness, poor balance, visual impairment, cognitive impairment, depression, alcohol misuse
  • Polypharmacy, psychoactive drugs, and postural hypotension
  • Environmental hazards

3

Name four complications of falls

  • Injury, injury-related disability, and death
    • ​Lacerations, traumatic brain injury, fractures
  • Distress
  • Pain
  • Loss of self-confidence
  • Reduced QoL, functional decline, depression
  • Loss of independence
  • Social isolation and activity avoidance
  • Institutionalisation

4

Identify the key elements of a falls history

  • Collateral Hx
  • Isolated or multiple falls
    • Any pattern, frequency, common precipitants, alcohol
  • Cause of fall: including environmental
  • Surrounding scenerio
  • Perceived functional ability and fear of falling
  • Urinary incontinence
  • Any loss of consciousness
  • Warning signs
  • Recovery and post-fall period

5

Name four common causes of falls and how to distinguish between them

  • Vasovagal syncope
    • LOC, straining, prolonged standing
  • Vertigo: room spinning
  • Orthostatic hypotension
    • Lightheadedness, shortly after standing
  • Seizures: biting tongue, incontinence
  • Muscular weakness, gait and balance impairment
  • Environmental
  • Incontinence
  • Visual impairment
  • Delrium and dementia

6

Outline the examination of a falls patient

  • Mental state
  • Visual impairment
  • Cardiovascular examination
    • Heart rate and rhythm
    • ECG
    • Lying and standing BP
  • Neurological and locomotor examination
  • Timed Up and Go Test
    • Rise from chair without using arms
    • Walk 3m
    • Turn around and sit down again
  • Turn 180o Test: >4 steps indicates need for futher assessment

7

What management options are available to prevent future falls?

  • Strength and balance training
  • Exercise in extended care settings
  • Home hazard assessment and safety intervention
  • Medication review
    • esp. regarding psychotrophic medications
  • Falls prevention programmes
  • Orthostatic hypotension
    • Adequate salt and water intake
    • Fludrocortisone
  • Cardiac pacing where indicated
  • Vision assessment and referral
  • Education and information giving
    • Motivation re exercise, strength, and balance
    • Preventable nature of falls
    • Coping aid

8

What are drop attacks?

Unexpected falls of unknown cause with no loss of consciousness

9

Name 2 causes of drop attacks

  • Carotid sinus hypersensitivity
  • Orthostatic hypotension
  • Milder cardiovascular disease
  • TIAs

10

Define orthostatic hypotension

A fall of at least during lying and standing blood pressure:

  • SBP 20 mmHg
  • DBP 10 mmHg

11

Name four medications known to cause orthostatic hypotension

  • Diuretics
  • Vasodilators: CCB and nitrates
  • ACEi
  • Alpha-blockers
  • Tricyclic antidepressants
  • Levodopa
  • Beta-blockers
  • Insulin