Falls + Fractures Flashcards
(29 cards)
What conditions with vision may affect the balance system? (4)
- Cataracts
- Age related macular degeneration
- Diabetic retinopathy
- Bifocal lenses
What conditions may affect proprioception (thus affecting the balance system) (3)
- Sensory neuropathy
- Joint replacements (lose proprioception)
- Ageing
What conditions of the vestibular system may affect balance? (3)
- Previous middle ear infections
- Meniere’s disease
- Ototoxic drugs (NSAIDs, aspirin, aminoglycosides)
What conditions of the brain/CV system may affect balance? (4)
- Cerebrovascular disease
- Dementia (affects judgement)
- Low BP
- Delirium (e.g. from infective cause)
What neuromuscular causes may affect balance? (3)
- Proximal myopathy (eg steroid exposure, vit D defc)
- Any neurological disease
- Disuse atrophy
What are intrinsic RFs for falls related to? (4)
- How well person can see
- How well they can walk or maintain their balance
- What kind of muscle strength they exhibit
- How well they can endure physical activity
List the main intrinsic RFs for falls (11)
Balance/gait problems: Stroke/Neuropathy/Parkinsons/Arthritis/Vestibular
Visual impairment (bifocal / glaucoma / ARMD / retinopath)
Cognitive problems: delirium/dementia
Urinary incontinence: urgency/frequency
List the main extrinsic RFs for falls (5)
Footwear Polypharm Sedatives/ CV med SEs Lighting/stairs/rug Lack of equipment
What are the short term complications of falls, due to trauma? (4)
o Soft tissue injury
o Fragility fractures (mortality and morbidity)
o Joint dislocations
o Subdural haemorrhage
What are the short term complications of falls, due to ‘long lie’? (4)
o Hypothermia
o Pressure sores
o Dehydration / AKI
o Infection (pneumonia)
What are the short term psychological (1) + social (2) complications of falls?
Psycho: loss of confidence / fear of falling
Social: Reduced mobility / Increased dependance
What are the long-term adverse complications of falls (7)
Fear of falling
Depression/Anxiety
Social Isolation
Injuries/Fractures
Death
Carer strain
Institutionalisation
What things should be included in the Hx in a falls pt (7)
- Sx, circumstances, eye witness account
- Any loss of consciousness
- 1st fall / Recurrent falls
- PMH → any falls RFs
- DH → any falls RFs / recent changes
- Alcohol
• Baseline cognition, function, mobility
What things should be included O/E in a falls pt? (5)
- Cognitive assessment
- Cardiovascular (pulse, L/S BP, murmurs, bruits)
- Neurological
- Feet, joints, eyes
- Gait (get up and go)
What Ix should be done in a falls pt? (2)
ECG
Postural BP
Possibly TILT assessment
What interventions may be done to reduce intrinsic factors of falls (3)
+ to reduce extrinsic factors (1)
Intrinsic - Physio:
Cardio training (bike)
Strength training (weights)
Balance training
Extrinsic - OT:
OT home assessment/adjustments
Outline the assessment (3) /management (2) for a falls patient
Dx reason for fall (eg visual disturbance)
Look for postural hypotension
Bone health assessment – past fractures, poss DEXA
Optomise management of contributing conditions
(eg cataracts, diabetes, overactive bladder)
Medication review
(minimise antihypertensives / start on Ca + VitD)
List certain types of drugs that are known to increase falls risk (+how) (8)
- Beta-blocker → hypotension
- Nitrates → hypotension
- Diuretics → hypotension
- BZDs → sedation
- Antihistamines → sedation
- TCAs → sedation
- Neuroleptics → sedation, muscle tremors/ spasms
- Steroids → proximal muscle weakness, osteoporosis
Define osteoporosis
A condition of skeletal fragility characterised by reduced bone mass and micro architectural deterioration predisposing to an increased risk of fractures
Describe the aetiology behind osteoporosis
Normal processes of bone formation/resorption become uncoupled or unbalanced → bone loss
List the clinical features of osteoporosis (3)
Asymp
Pain / loss of height with kyphosis development (due to spine fragility fractures)
Features of underlying disease (eg Cushing’s syndrome)
List some secondary causes of osteoporosis (16)
Genetic: Marfans/Turners/Osteogenesis imperfecta
Inflammatory: RA/Ank Spon/IBD
Iatrogenic: Steroids/Sex-steroid antags/Lithium/Heparin
Endocrine: Cushings/Acromegaly/Hypopituitary/Prolactinoma
Nutritional: Ca+VitD defc / Malabsorption
List the RFs for osteoporosis (12)
o Age o Women (men more likely 2o cause) o Previous fracture o FH o XS alcohol o Smoking
o Drugs (steroids/ heparin/ phenytoin) o Amenorrhoea for 6m (excl pregnancy) o Late menarche/ early menopause o Immobility/ physical inactivity o Inflammatory arthritis o Gastrectomy
What are the T score ranges (DEXA) for osteopenia/porosis?
Whats the diff b/wn T score + Z score
Osteopenia = T -1SD to -2.5SD Osteoporosis = T < -2.5SD
T score = compared to young healthy adult
Z = compares to similar age (used in <50s)
