Flashcards in Geriatrics - Falls Deck (15):
What are some key epidemiological features of falls? (What is the mortality following a NOF? What is the recurrence rate for falls? Is death following a fall equal for men and women?)
Some key points:
- death following a fall is higher in women compared with men aged over 75
- following a hip fracture, 1/3 of patients become totally dependent
- 1 year mortality following a NOF is 20-35%
- 50% of people aged 80+ have at least one fall per year
- 50% of those who fall will fall again
- 1% of falls are associated with a hip fracture
Outline an approach to assess a patient who has fallen?
- a fall is NOT a diagnosis; it is a presenting complaint
- it is essential to diagnose the cause of a fall
- ALL forms are mechanical - i.e. some form of mechanism is involved
- most health professionals who talk about a mechanical fall are referring to an environmental cause of the fall
What adverse outcomes are associated with falls?
1) Fear of falling
2) Social isolation
3) Injuries and fractures
5) Carer strain
7) Depression and anxiety
How do national guidelines suggest patients should be screened for risk of falls?
By asking them if they have had a fall! The predictive properties of falls risk screening tools compared to asking patients if they have had a fall are the same.
What are intrinsic risk factors for falls?
Intrinsic risk factors are basically related to how well a person can see, how well they can maintain their balance and walk, what kind of muscle strength they exhibit and how well they can endure physical activity.
Diseases that affect the cardiovascular, neurological, or musculoskeletal system can increase an older persons risk of falling.
E..g. thyrotoxicosis, metastatic prostate cancer, PD, cataracts, diabetes, osteoarthritis
What are extrinsic risk factors for falls?
Extrinsic risk factors are related to the persons physical environment including their home, such as poor lighting, slippery floors, or throw rugs.
This factor also includes medication and assisted devices. Medication that can increase the risk of falling includes BDZ, antipsychotics and antidepressants.
What systems are required to maintain upright posture?
What diseases that affect vision can lead to falls?
Vision is required for spatial orientation.
Diseases such as cataracts, age related macular degeneration, diabetic retinopathy and bifocal lenses can all increase the risk of falling.
How can proprioception be affected causing falls?
Proprioception or joint position sense helps with orientation when the eyes are shut or vision is impaired.
Diseases such as sensory neuropathy, joint replacements and ageing can all increase the risk of falling.
Outline an approach to falls prevention?
Falls prevention involves 3 aspects:
1) Strength and balance training
2) Home hazards assessment
3) Medical review
This aims to address the intrinsic risk factors (e.g. poor visual acuity or reduced balance) as well as extrinsic deficits such as unnecessary medication.
What strength and balance training techniques are used to help with falls prevention?
Therapy might involve a variety of activities such as cardiovascular training (e.g. on an exercise bike), strength training (using resistance exercises) and balance training (e.g. using a wobble board). This usually lasts many weeks - some people suggest up to 50 hours may be required.
Physiotherapists are involved in strength and balance training.
Who undertakes a home hazards assessment?
OT's will visit a patients home and identify all the potential hazards that may be contributing to a patients fall. Particular areas to focus on are the bath, toilet, cluttered living spaces, rugs, lighting etc.
They can also recommend equipment that can help with patients ADLs.
What are the 4 aspects of medical assessment for patients who have fallen?
1) Diagnose medical reasons for falls - e.g. cardiovascular, neurological, infection, ophthalmic, psychiatric etc
2) Optimise management of conditions that could contribute to falls
3) Bone health assessment - e.g. DEXA scans for patients with a history of bone fractures
4) Medication review
What investigations should all patients presenting with a fall have?
ECG and check for postural hypotension should be performed in ALL patients presenting with a fall.
Postural hypotension is a sensitive, but not a very specific test for falls, as its absence at the time it is checked does not rule out that is has not occurred prior.
A drop of 20mmHg systolic or 10mmHg diastolic from sitting to standing is highly suggestive of orthostatic hypotension.