Geriatrics II and Falls Assessment Flashcards Preview

Unit 2 > Geriatrics II and Falls Assessment > Flashcards

Flashcards in Geriatrics II and Falls Assessment Deck (14):
1

What defines a fall, in general?

  • Definition: coming to rest inadvertently on the ground or at a lower level
  • Most falls are not associated with syncope (falls lit. usu. excludes falls assoc. w/ LOC)
  • Common in geriatric patients, where it is often a marker of poor health/declining function
     

2

What are the three levels of age in geriatric patients?

  1. "Young old": 65-74yo
  2. "Middle old": 75-84yo
  3. "Old old": 85+yo

3

What are risk factors for falls?

  • Age (esp. 75+yo)
  • Female
  • Low mobility (use of cane/walker)
  • Low body weight
  • Impaired gait and balance
  • Limited activities of daily living
  • Acute illness
  • Chronic illness
     

4

What are some sequelae of falls?

Associated with:

  • Decline in functional status
  • Nursing home placement
  • Increased use of medical services
  • Fear of falling

Half of those who fall are unable to get up without help → “long lie” → predicts lasting decline in functional status

5

What are some age-related changes?

  • Broad-based gait, poor gait initiation
  • Flexion of cervical spine, hips, and knees
  • Decreased arm swing
  • Smaller steps
  • Stiff turns
  • Dec. baroreceptor sensitivity
  • Postural hypotension
  • Vision changes
  • Decreased total body water
  • Decreased proprioception
     

6

What are some intrinsic factors for falls?

  • Slower reflexes
  • Decreased reaction time
  • Increased postural sway
  • Decreased vision
  • Cognitive impairment
  • Alcohol use
  • Medications

7

What are some extrinsic factors for falls?

  • 4+ meds
  • Poor lighting
  • Unsafe stairways
  • Clutter
  • Irregular walking surface
  • Pets
  • No grab bars or handrails
  • Improper footwear
     

8

What are some medications highly associated with falls?

  • Benzodiazepines
  • Sleeping meds
  • Antidepressants
  • Anithypertensives
  • Cardiac meds
  • Diuretics
     

9

What are some things to examine in geriatric home safety checks?

  • Secure carpets, remove throw rugs
  • Reduce clutter
  • Remove wires, cords, low chairs/furniture
  • Check lighting, access to phone
  • Handrails/grab bars
  • Rubber mats in bathtub
  • Raised toilet seat
  • No floor wax
  • Secure stairs
  • Shelves, step stools
     

10

What should be done for geriatric patients who have had single or recurrent falls?

  • Ask all older adults about falls in past year
  • Single fall: check for balance/gait disturbance
  • Recurrent falls or gait/balance disturbance: obtain relevant medical history, physical exam, cognitive and functional assessment; determine multifactorial falls risk

11

What is involved in the physical exam for geriatric patients who have fallen?

  • Blood pressure and pulse, both supine and standing
  • Vision screening
  • Cardiovascular exam
  • Musculoskeletal exam
  • Neurologic exam
     

12

What laboratory/diagnostic testing is advised or advised against for geriatric patients who have fallen?

Advised:

  • Tests and procedures should be guided by the history and physical exam: echocardiography, brain imaging, radiographic studies of spine
  • Hemoglobin, serum urea nitrogen, creatinine, glucose: can exclude anemia, dehydration, or hyperglycemia

Advised against:

  • Holter monitoring: NO PROVEN VALUE for routine evaluation
  • Carotid sinus massage with continuous heart rate and BP monitoring: can uncover carotid sinus hypersensitivity
     

13

What is the Get up and Go Test?

  • Time person as they rise from a standard chair
  • Walk 10 ft, turn, walk back to the chair and sit down again
  • OK to use walker or cane
  • Do one practice trial and then three actual trials. Average the times from the three actual trials to get the score

Scoring:

  • < 10 seconds: freely mobile
  • <20 seconds: mostly independent
  • 20-29 seconds: variable mobility
  • >30 seconds: impaired mobility 

14

What are multifactorial interventions for older adults and those who have falls?

  • Minimize medications
  • Initiate individually tailored exercise program
  • Treat vision impairment
  • Manage postural hypotension, heart rate and rhythm abnormalities
  • Supplement vitamin D
  • Manage foot and footwear problems
  • Modify the home environment