GERI-FaLLs Flashcards
(68 cards)
1
Q
What things are included in mobility?
A
-walking -climbing stairs -getting in/out of cars -transfers: to and from bed, to and from a chair, to and from a wheelchair -getting up from the floor
2
Q
What percentage of community dwelling elders have difficulty walking?
A
SNF- 40%, CA-8-19%,All >85-54%
3
Q
How does gait change with advanced age?
A
- decline in gait speed
- stride length diminishes
- not due to decrease in cadence
- balance declines
4
Q
What are common gait charcteristics of 80yos?
A
- shorter, broader strides
- longer stance (wider)
- shorter swing duration
5
Q
What common diagnoses can leading to a gait disorder?
A
- DJD (arthritis)
- sensory impairment (DM)
- neurological disease -stroke, Parkinson’s
- postural hypotension/rx induced
- fear of falling
6
Q
What are the typical gait characteristics of sensory ataxia?
A
- sensorimotor level: peripheral; from posterior column & peripheral nn.
- gait: unsteady, esp w/out visual input
7
Q
What are typical gait characteristics of vestibular ataxia?
A
unsteady, weaving (“drunken”)
8
Q
What are typical gait characteristics of visual ataxia?
A
tentative, uncertain
9
Q
What are typical gait characteristics of arthritic conditions (antalgic, joint deformity)?
A
- avoids weight bearing on affected side, shortens stance phase
- painful hip may produce Trendenlenburg gait
- painful knee is flexed
- painful spine produces short, slow steps and decreased lumbar lordosis
- contractures, deformity-limited motion, buckling with weight bearing
- kyphosis and ankylosing spondylosis produce stooped posture
10
Q
What are typical gait characteristics for myopathic and neuropathic (weakness) abnormalities?
A
- pelvic girdle weakness produces exaggerated lumbar lordosis and lateral trunk flexion
- proximal motor neuropathy produces waddling and foot slap
- distal motor neuropathy produces distal weakness exaggerated hip flexion, knee extension, foot lifting and foot slap
11
Q
What are typical gait characteristics of hemiplegia/paresis?
A
- leg swings outward and in semicircle from hip
- knee may hyperextend and ankle plantar flex and invert
12
Q
What are typical gait characteristics of paraplegia/paresis
A
- both legs circumduct,
- steps are short shuffling and scraping
- if severe, hip adducts so that knees cross in front of each other
13
Q
What are typical gait characteristics of Parkinsonism
A
- small shuffling steps, hesitation, acceleration, falling forward, falling backward
- moving the whole body while turning (en bloc), absent arm swing
14
Q
What are typical gait characteristics of cerebellar ataxia?
A
wide-based with increased trunk sway, irregular stepping, staggering, esp on turns
15
Q
What are typical gait characteristics of cautious gait?
A
fear of falling with appropriate postural responses, normal to widened base, shortened stride, decreased velocity, en bloc turns
16
Q
What are typical gait characteristics of cerebrovascular, NPH (frontal-related gait d/os)
A
frontal gait d/o: difficulty initiating gait and short shuffling gait similar to Parkinson’s but wider base, upright posture, preservation of arm swing, leg apraxia, may freeze w/ diversion of attention or turning may also have cognitive, pyramidal, and urinary disturbances
17
Q
What are some consequences of gait abnormalities?
A
- functional decline
- for community dwelling elders, predict higher risk of institutionalization
- increased morbidity and mortality **
18
Q
-drop in pelvis/weight to unaffected side- gluteus medius hip abductor weakness
A
Trendelenburg gait
19
Q
-backward trunk lurch persists to maintain center of balance -cause: hip extensor weakness
A
Gluteus maximus lurch
20
Q
-excess hip flexion to clear foot -cause: foot drop (common fibular n); can’t dorsiflex
A
Steppage gait
21
Q
-unsteady, uncoordinated, wide base, feet thrown out coming down on heel then toes -
cause injury to cerebellum, sensory deficits of lower limb
A
Ataxic gait
22
Q
-short stance 2/2 pain
A
Antalgic gait
23
Q
What are the annual fall rates for elderly pts?
A
33% community dwelling elderly
50% nursing home residents 50% sustain injury
24
Q
What are some of the MCC of falls?
A
- accident/environment
- gait/balance d/o
- dizziness
- drop attack (syncope)
25
Common risk factors for falling
- hx of falls
- gait and balance deficit
- strength deficit
- restraints
- arthritis
- uses assistive devices
- impaired ADLs
- depression
- cognitive impairment
- postural hypotension
26
What is important PMH to obtain in a pt who has fallen?
```
-hx of injuries, accidents -
falls w/in last 12mos
-hx of diseases and surgeries
-hx of orthopedic procedures
-hospitalizations
-medications
```
27
What are common medications that can contribute to falls?
- polypharmacy in general
- sedative hypnotics
- antidepressants
- antihypertensives
- cardiac meds
- hypoglycemic agents
- topical eye medications
28
ROS for someone who has fallen
-syncope? -
visual impairment? -
SOB? CP?
-neurological? --> sensory deficit, muscle weakness or pain, poor balance
29
What associated symptoms to ask about in a pt who has fallen?
- dizziness
- light-headedness
- vertigo
- syncope
- weakness
- confusion
- palpitations,CP
30
What are recurrent falls usually a result of?
-frequently due to to the same underlying cause
-can also be an indication of disease progression (parkinsonism, dementia, HF)
new acute problem
31
Important components of a post-fall assessment
- details of the fall (SPLATT)
- trauma check
- postural hypotension
- determine fall risk factors
- check incident reports
32
Important social/environmental history to obtain in a pt who has fallen
-home: multilevel/stairs, pets, hazards (rugs,cords, poor lighting)
-lives alone?
-assistive device? -
frequently leaves home?
-can they get in and out of the car?
33
How do we treat someone who has fallen in a SNF?
```
-neuro check q1hr x4 then q4hr x 24hr,
check VS,
check FSBS -PE: BP, HR, bruits?, nystagmus, CNx10, muscle testing,
MMSE
-PT/OT to evaluate pts home
```
34
How can syncope contribute to a fall?
causes: reduced flow through cerebral blood vessels, reduced CO, impaired oxygenation, peripheral vasodilation, diminished venous tone, leading to pooling of blood in lower extremities --> all leads to dizziness and loss of consciousness = fall
35
What are the types of syncope?
- neurally mediated
- orthostatic hypotension
- cardiac
- drug-induced
- multifactorial
- unexplained
- cerebral vascular disease
- psychogenic
36
What are common causes of neurally mediated syncope?
-vasovagal; situational
- defecation, urination, coughing, eating;
MC-carotid sinus syncopes
37
What are common causes of orthostatic hypotension?
- autonomic failure from underlying disease
- Parkinson's, spinal cord injury
- drug-induced
- EtOH, vasodilators, diuretics, phenothiazines, antidepressants
- volume depletion
38
What are common causes of cardiac syncope?
-arrhythmias (bradycardia, tachycardia)
-structural heart disease
- valvular disease, acute infarction, hypertrophic cardiomyopathy,
cardiac mass, tamponade
*CP or dyspnea strong clue
39
What are common causes of drug-induced syncope?
-EtOH, vasodilators, diuretics, phenothiazines, antiarrhythmics, QT-prolonging drugs
40
What are common causes of cerebral vascular disease syncope?
-stroke -TIA -seizure
41
What are the two biggest body systems causing syncope that we worry about?
cardiac & nervous system!
42
How can you use carotid sinus massage to help determine what is causing syncope?
Nothing happens - negative carotid sinus massage test If BP drops or HR slows and pt gets dizzy/faint - positive carotid massage test
*can indicate neurally mediated syncope
43
What are criteria that suggest cardiac etiology of syncope that should prompt hospitalization?
-syncope while supine
-syncope during exertion
-palpitations prior to syncope
-family hx of sudden cardiac death -
hx of previous MI -low EF -signs of HF -abnormal EKG -systolic BP <90mmHg
44
What questions should you ask when a pt presents after a fall c/o dizziness?
- was the onset sudden?
- is the dizziness constant or periodic? -how long do the episodes last? -how is the dizziness impacting the patient's life?
45
What common causes of dizziness can often cause falls?
- postural hypotensin
- benign positional vertigo
- anxiety
- depression
- cardiac arrhythmia
46
What body system classically causes dizziness prior to a fall?
cardiac! start here
47
What type of dizziness would one describe with vertigo?
spinning, sense of rotation
48
What might be on your differential if the dizziness is episodic?
recurrent vestibulopathy, BPPV, TIA, Meniere's disease
49
What might be on your differential if the dizziness if continuous?
meds, psychological
50
How should you treat dizziness in old age?
- identify primary diagnosis and use a specific therapeutic agent,
- provide symptomatic relief
- identify contributing sensory deficits and manage them
- exercise can treat BPPV, reduce balance problems, lower risk of falls
- if at risk of falls, consider walking aid and home assessment
51
How can we ask providers decrease the risk of falls?
- obtain hx of falls
- perform a fall-risk assessment
- initiate an intervention
52
What is encompassed within a fall-risk assessment?
-gait examination:
asymmetric weight distribution
5 meters adequate to assess slow (0.6 meter/second) predicts hospitalization and functional decline
53
What is the Timed Get Up and Go test?
Time necessary to: -stand up from a chair with arms -walk 3m (10ft) -turn -walk back to the chair -sit down Most adults can complete in 10sec
Frail elders can complete in 11-20 seconds
>14s = increased fall risk
>20s = comprehensive eval indicated
54
What factors can be modified to help decrease fall risk?
- meds (psychotropics)
- muscle weakness
- hypotension
- remove restraints
55
What are some nonmodifiable factors that increase risk of falls?
-hemiplegia -blindness
56
What Intrinsic fall interventions can be implemented to help decrease risk for falls?
-treat underlying disease
-eliminate drugs and dosages
-initiate PT
initiate exercise
57
What Extrinsic fall interventions can be implemented to help decrease risk for falls?
- reduce environmental hazards
- reduce/remove restraints
- improve fall surveillance
- consider protective pads and floors and/or a low bed
58
What three areas does general rehabilitation cover?
- normal aging, disuse and deconditioning (strength, balance, coordination)
- cardiovascular problems like vascular disease and stroke -skeletal problems: osteoporosis and osteoarthritis, knee and hip replacements
59
What are the goals for pts when they are engaged in rehab therapy?
- complete recovery with full, unrestricted function
| - recovery ADLs
60
What do the results of rehab depends on?
MOTIVATION
61
What is rehab like at an acute care hospital?
most extensive and intensive care pts w/ good potential for recovery and can participate in and tolerate aggressive therapy >3h/d
62
What is rehab like at a SNF?
less intensive programs 1-3h/d, up to 5d/wk
| pts less able to tolerate therapy
63
What is rehab like with home health?
less varies and less frequent rehab 3x/wk
| *this is generally not enough
64
What is important to include when writing the referral for therapy?
-referral should state the diagnosis and goal of therapy -specific as possible
65
What is occupational therapy? What do they generally work with?
-self-care activities and improvement of fine motor coordination of muscles and joints, particularly in the upper extremities -ADLs --> the cornerstones of independent living
66
What is physical therapy? What are their goals and what do they work on?
- improve joint and muscle function and thus improve pts ability to stand, balance, walk, climb stairs,
- usually used to train lower-extremities, gross motor skills, ROM; strength and conditioning; coordination exercises; proprioceptive neuromuscular function; ambulation exercises; transfer training
67
What disorders can speech therapists help with?
- expressive aphasia: letter or picture board
- dysarthria or apraxia: breathing and muscle control plus repetition exercises, electronic device w/ keyboard and message display
- postlaryngectomy: new way to produce a voice
- diagnosis and treatment of swallowing d/o
- cognition!
68
What therapeutics and assistive devices are available for pts?
-orthoses -walking aids -wheelchairs -mobility scooters -protheses
