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Special Pops - Geriatrics > Falls in the Elderly > Flashcards

Falls in the Elderly Flashcards

(75 cards)

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1
Q

Falls in the elderly are linked to:

A

Increased morbidity and mortality

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2
Q

Fear of falling can predispose someone to:

A

Future falls

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3
Q

What is going to be investigated for its potential in preventing falls?

A

Balance confidence (perceived self-efficacy)

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4
Q

How many people over 65 fall every year?

A

1 in 3

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5
Q

Those who fall are at least ___ as likely to fall again

A

Twice

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6
Q

How many falls cause serious injury?

A

1 in 5

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7
Q

What % of elderly fear falling?

A

Around 30%

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8
Q

What % of people 65 and over fall in a given year?

A

35-40%

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9
Q

What % of people over 80 yo fall in a given year?

A

50%

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10
Q

What % of people 65 or older visit the ED because of a fall related injury? Of these, how many are admitted?

A

8% with half of these being admitted

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11
Q

Falls account for what percentage of fractures in the elderly?

A

87% of all fractures (and more than 95% of hip fractures)

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12
Q

What are the different types of risk factors for falls?

A

Extrinsic (environmental)
Intrinsic
Predictive

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13
Q

What are intrinsic risk factors for falls?

A
  • Biological: weakness, gait/balance problems, poor vision

- Behavioral: meds, risky behaviors, inactivity, depression, cognitive impairment

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14
Q

Where do most falls occur?

A

In the home (85%)

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15
Q

Environmental risks for falls

A
  • Home clutter/hazards
  • Support surface
  • Poor lighting
  • Clothing
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16
Q

What % of falls occur in the home?

A

85%

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17
Q

If someone has 0-1 risk factors, what is their risk % of falling each year?

A

27%

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18
Q

If someone has 4 or more risk factors, what is their risk % of falling each year?

A

78%

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19
Q

Maintaining balance during body movements requires:

A

A reaction to restore the person’s displaced center of mass over the base of support

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20
Q

What does adequate postural control require?

A

Keeping center of gravity over base of support during BOTH static and dynamic situations

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21
Q

How must the body be able to respond to changes in center of gravity?

A
  • Intentional movement

- Involuntary or unexpected movement (slips, trips)

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22
Q

What factors must integrate in order for postural control to occur?

A

Vision, vestibular and proprioceptive input by the CNS

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23
Q

The area over the feet within which a person is able to lean ____ with age

A

Decreases

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24
Q

What does impaired performance of static balance tasks affect?

A

Walking and transferring

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25
What are the action systems in postural control?
- Higher level planning: frontal and motor cortex - Coordination: brainstem, spinal networks coordinating muscle response synergies - Generation: motor neurons and muscles
26
How can changes in postural tone be verified?
EMG
27
How can changes in postural tone be assessed?
Changes can be seen in certain anti-gravity muscles during normal upright standing (and can be verified with EMG)
28
Motor control of quiet stance consists of:
Alignment Muscle tone Postural tone
29
Which muscles are activated and contribute to postural tone at rest?
Anti-gravity muscles - Gastroc/soleus - Tibialis anterior - Gluteus medius and TFL - Iliopsoas - Thoracic erector spinae
30
Why does the gastroc/soleus group activate in postural tone?
Line of gravity is anterior to knee and ankle
31
When does the tibialis anterior activate to maintain postural tone?
When body sways backward (opposes the gastroc/soleus)
32
How does the iliopsoas help control postural tone?
Prevents hyperextension of hips
33
Why do the thoracic erector spinae muscles activate in postural tone?
Line of gravity falls in front of spinal column
34
What affects loss of postural balance in the elderly?
- Speed or magnitude of displacement - Inability to quickly detect displacement b/c slowing of CNS sensory into motor response - Muscle weakness or joint pain causing slow motor response
35
What affects stance control?
Position and velocity of the COM
36
What are the strategies underlying stance postural control?
Motor Sensory Sensorimotor
37
How do the gluteus medius and TFL contribute to postural tone?
Assist with proximal control
38
What strategies are employed to keep anteroposterior stability?
- Ankle - Hip - Stepping
39
Define ankle strategy
- For anteroposterior stability | - Response to small perturbation on a firm surface
40
Define hip strategy
- For anteroposterior stability | - Response to a larger faster perturbation on a smaller or compliant surface
41
Define stepping strategy
- For anteroposterior stability | - Response to strong perturbation, enough to displace COM outside of BOM
42
Which anteroposterior stability is the response to a STRONG perturbation?
Stepping strategy
43
How is central processing affected with age?
Neuro diseases can cause impairments (Parkinson's, stroke, NPH, etc.)
44
What is the consequence of weak hip abductors/adductors in the elderly?
Decreased ability to maintain balance while stepping to avoid a fall
45
What foot problems can cause balance issues in the elderly?
Calluses and bunions affect sensory skills
46
What factor is more highly correlated with physical function than muscle strength?
Muscle POWER
47
How does skeletal muscle change with age?
- Loses both Type I and II fibers - Number of motor units declines - Number of myelinated fibers declines
48
What shows the greatest decline with age compared with all other joints?
Spinal flexibility (d/t spinal stenosis, thoracic kyphosis, cervical spondylosis)
49
What % of 65 and older experience postural hypotension?
10-30%
50
Define postural hypotension
Drop in SBP of 20 mmHg or more with change in position from lying to standing
51
What causes postural hypotension?
- Meds - Dehydration - Age associated changes affecting autonomic control of vascular tone
52
Define "self-efficacy"
A person's perception of their ability to master a given type or level of performance in certain settings
53
Define "fear of falling"
A diminished perceived self-efficacy at preventing a fall during normally non-hazardous activities of daily living
54
Reduced self-efficacy for balance can lead to:
- Self imposed restrictions to activity - Deconditioning and loss of muscle mass - Fall-related anxiety producing muscle tension
55
Fear of falling is a predictive risk factor for:
- Poorer quality of life - Functional decline - Loss of independence
56
What are objective screening measures of fall risk?
- Berg Balance Scale - Timed Up and Go Test - Activities Specific Balance Confidence Scale
57
What is the ABC scale?
16 item scale that detects loss of balance confidence
58
What is the Berg Balance test?
- 14 items to assess balance, rated by an observer | - CANNOT use assistive device
59
What is the Timed Up and Go test?
Time it takes to go from sitting to standing, walk 3 m and returning to sitting
60
Scoring of ABC scale?
- Less than 50% indicate low level physical functioning - 50-80%: moderate - Over 80%: high functioning
61
What ABC score indicates a falls risk?
67% with about 85% sensitivity/specificity
62
Benefits of the ABC score
- Provides insight into "fear of falling" syndrome | - Facilitates active participation in interventions for falls risk reduction
63
Limitations of the ABC scale
- Not appropriate for all settings (some activities may not have been experienced by the participant) - Not a replacement for physical performance measures
64
What does the Timed Up and Go test assess?
Examines functional mobility in community dwelling older adults 70-84 yo
65
What TUG test result indicates high risk for fall?
Longer than 14 seconds
66
Disadvantages of TUG test
- Instructions for the test vary - Inconsistent start of timing - Measurement error
67
Benefits of Berg Balance test
- Well known - May detect cognitive impairment - Found to be a valid measure in many populations including stroke pts - Low cost
68
How to interpret Berg Balance test score?
- Many use 45 (out of 56) as a cutoff score to indicate impaired balance - Some use ranges 41-56 as low risk, 21-40 medium, 20-0 high risk
69
What cut off time of the Five times Sit to Stand test indicates fall risk?
13 seconds
70
What gait speed indicates being more dependent in one or more ADLs?
0.25 m/s
71
What gait speed is needed for elderly to cross street safely?
More than 1.0-1.2 m/s
72
What is the benefit to learning how to fall?
- More likely to roll with impact - LEAST amount of injury - Key is relaxation
73
Describe difficulty getting up after a fall
- Associated with substantial morbidity - 51% in the community unable to get up unassisted - 85% NOT a/w serious injury - Over 20% remain on floor for over 1 hour
74
How is physical restraint used to reduce falls in hospital?
LAST RESORT - not been shown to decrease incidence of falls
75
A decrease in 1 SD of femoral neck bone mineral density increases the risk of hip fracture ___ times
2.7

Special Pops - Geriatrics (9 decks)

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