Falls in older people Flashcards
(24 cards)
What is the definition of a fall?
An event which causes a person to, unintentionally, rest on the ground or lower level
Not as the result of a major intrinsic factor (e.g. stroke)
What are the biological consequences of falls?
Fractures
Head injury (subdural haematoma)
Soft tissue injuries (bruises, bleeding)
Burns (into oven, fire etc.)
Long lies on floor (can lead to pressure sores, hypothermia, pneumonia etc.)
What are the psychological consequences of falls?
Fear (loss of confidence, immobilisation)
Depression (reduced independence and social interaction)
Anxiety (social anxiety, agoraphobia, panic) - in both patient and families/ carers
What are the social consequences of falls?
Loss of independence (institutionalisation, loss of social interaction)
Impact on others (family tension/ stress)
At what time of day do most falls happen?
Mid-afternoon
Relationship with circadian rhythms (circadian dip)
What are the common intrinsic factors related to falls?
Syncope Dizziness Seizures Peripheral neuropathy Visual impairment Medication side effects Cognitive problems Age-related frailty Motor problems (e.g. Parkinson's)
What is syncope?
Sudden, transient loss of consciousness due to reduced cerebral perfusion
Generally spontaneous recovery
What are the common causes of syncope?
Situational hypotension Vasovagal (vagal stimulation) Carotid sinus syndrome Cardiac arrhythmia / ischeamia Outflow obstruction (e.g. aortic stenosis) Pulmonary embolism
What are the common extrinsic factors related to falls?
Poor lighting Clutter/ cables/ rugs Pets/ children Inappropriate footwear/ use of mobility aids Unfamiliar environment
What are the common causes of falls?
Drugs (polypharmacy - multiple medications)
Age-related changes (gait, balance, sensory impairment)
Medical (syncope, PD, stroke)
Environmental
[MULTIFACTORAL]
How should a history of a fall be taken?
Symptoms (e.g. preceding fall) Previous falls (e.g. multiple falls?) Location Activity Time (e.g. in afternoon dip, after meal etc?) Trauma (any injuries?) Drug history
What examinations should be done when assessing a fall?
General appearance Gait/ balance Pulse (rate + rhythm) Postural hypotension Murmurs Neurological examination (e.g. signs of Parkinson's?) Vision and hearing Neck/ head movement Screening for cognitive impairment?
How can visual changes with age increase chance of falling?
Use of bifocals Glaucoma Macular degeneration Cataracts Retinopathy (e.g. diabetic)
What needs to be established when assessing cognitive impairment following a fall?
Acute vs. chronic Medical causes (e.g. hypothyroidism, hyponatraemia, hypoglycaemia, vitamin deficiency, drugs/ alcohol)
What investigations could be carried out following a fall?
Bloods (FBC, U+Es, TSH, Glucose, B12, folate, Calcium/ phosphate) BP ECG/ 24 hr ECG CT head EEG
What are the NICE guidelines for assessing and managing falls?
Routinely ask r.e. falls history in past years (“Get up and go” test)
Referral to specialist falls service - multifactoral risk assessment
What should a multifactorial risk assessment include?
Physiotherapist: Individualised strength and balance training
OT: Home hazard assessment and intervention
Optician: Vision assessment and referral
GP/ hospital physician: Medication review with modification/withdrawal and management of causes and recognised risk factors
What is most likely intervention to reduce risk of falls?
Targeted physiotherapy (tailored physical exercise programmes)
What changes in blood pressure are classified as postural (orthostatic) hypotension?
20mmHg fall in systolic and/or 10mmHg fall in diastolic within 3 minutes of standing (with symptoms)
What can cause postural hypotension?
Drugs Chronic hypertension Volume depletion Autonomic failure (e.g. PD, DM) Prolonged bed rest Adrenal insufficiency
How is postural hypotension treated?
Treat the cause
Consider fludrocortisone or desmopressin
What is post-prandial hypotension?
A fall of >20mmHg in systolic BP after the ingestion of a meal (can have an effect for up to 90 mins)
How can post-prandial hypotension be treated?
Alter timing of anti-hypertensives
Lie/ sit down after meal
Caffeine, fludrocortisone, NSAIDs
NICE guidelines multifactoral risk assessment
Assessment/identification of:
falls history
gait, balance and mobility, and muscle weakness
osteoporosis risk
patient’s perceived functional ability and fear of falling
visual impairment
cognitive impairment and neurological examination
urinary incontinence
home hazards
cardiovascular examination and medication review
