Falls and Incontinence

Question 1

Falls Statistics

Answer 1

35-40% yrly in community dwellers >65%
30-50% of nursing home residents
5-16% in acute hospital

6-40% cause serious injury - risk of hip fractures 10x higher in residential care than in the community

Fear of falling is the greatest fear for older people
-> decline in ADLs and social function

Question 2

Risk factors

Answer 2

History of falls
ADL limitations

Advanced age
Impaired gait/immobility
Impaired sit to stand
Impaired transfers
Visual impairment
Reduced peripheral sensation
Muscle weakness
Psychoactive medications
Use of >4 meds

Question 3

Falls management

Answer 3

Multidisciplinary interventions
Medication review
Exercise
Footwear
Cataract repair
Alarm mats 
Scheduling toileting

Question 4

Hip fracture risk factors

Answer 4

Age
Females
History of falls
Cognitive impairment
Psychoactive medications
Visual impairment
OP

Question 5

Incontinence rates

Answer 5

10% of community dwelling
>80% in nursing home

1 in 3 women

URGE incontinence most common

Question 6

Causes of incontinence

Answer 6

Impaired central control:
- Drugs - sedatives, hypnotics, antipsychotics, antidepressants, antiemetics, alcohol

Impaired bladder function:

• Anticholinergics and cholinergics
• Bladder irritants - Caffiene

Decreased outflow resistance:
- alpha blockers

Increased outflow resistance
- TCAs and pseudoephedrine

Question 7

Treatment of incontinence

Answer 7

Pelvic muscle exercises - stress incontinence
Bladder retraining - urge incontinence

Timing of fluids, medications and caffeine
Treat constipation
Weight loss

Scheduled toileting
Continence aids

Antimuscarinic agents
Topical oestrogen

Mid urethral sling