Instability and Falls in Elderly Population Flashcards
(67 cards)
1
Q
The prevalence of falls among the elderly is linked to what?
A
increased morbidity and mortality
2
Q
What can predispose an individual for future falls?
A
fear of falling
3
Q
Balance confidence (perceived self-efficacy) is investigated fore its clinical implications for what?
A
fall screening and prevention stages
4
Q
How many people 65+ fall every year?
A
1 out of 3 people
5
Q
How likely is a person to fall again after experiencing a pervious fall?
A
twice as likely
6
Q
Of the elderly that fall how many cause serious injury?
A
1 out of 5 falls cause serious injury
7
Q
What is the leading cause of accidental death in the home?
A
Falls
8
Q
what happens to an elderly patient who are hospitalized after a fall?
A
hospital stays are almost twice as long in elderly patient who are hospitalized after a fall than those admitted for other reasons
9
Q
what % of people 65years old and over fall in a given year
A
35-40%
10
Q
what % of people 80 years old and older fall in a year
A
50%
11
Q
what % of people 65 years or older visit the ED because of a fall related injury?
A
8%
12
Q
Falls account for what % of all fractures and what % of hip fractures in this group
A
falls account for 87% of all fractures and for more than 95% of hip fractures
13
Q
What are risk Factors for Falling?
A
Gait/Balance deficit Visual/Hearing deficit MSK impairment Neuro/Cognitive Impairment Depression Using Assistive devices Meds Age>80 years old
14
Q
What are Intrinsic Risk Factors for falls?
A
Weakness, Fall Hx Balance/Gait instability Assistive device use Visual Impairment Arithritis, ADL deficits Depression Cognitive Impairment Over 80 years old Lifestyle factors
15
Q
Where do most falls occur with the Elderly population?
What are environment risk factors for falls
A
85% of falls occur in the Home RF: clutter/hazards support surface railing safety Poor lighting Obstacles Clothing
16
Q
what is the risk of falling in an elderly with 0-1 risk factors
A
27% risk of falling
17
Q
what happens to a patient risk of falling if they have 4 or more risk factors
A
78% risk of falling
18
Q
what is postural control
A
Maintaining balance during body movements requires a reaction to restore the person’s displaced center of mass over the base of support
19
Q
what is needed to maintain adequate postural control
A
requires keeping COG and BOS (base of support) during both static and dynamic situations
the body must be able to respond to changes in COG d/t:
intentional movement
Involuntary or unexpected movement
20
Q
postural control is dependent on what?
A
on the integration of visual, verstibular and proprioceptive input from the CNS
21
Q
Loss of balance results from?
A
- speed or magnitude of displacement
- Inability to quickly detect the displacement b/c sensory impairment, slowing of the CNS sensory info into motor response
- muscle weakness or joint pain causing slow motor response
22
Q
motor strategies for postural control?
A
organized movement appropriate for controlling body’s position
23
Q
sensory strategies for postural control?
A
organizes sensory info from visual somato-sensory, and vestibular systems for postural control
24
Q
sensorimotor strategies
A
reflect rule for coordinating sensory and motor aspects of postural control
25
what are parts of anteroposterior stability?
ankle strategy
Hip strategy
stepping strategy
26
ankle strategy
response to small pertubation on a firm surface
27
hip strategy
response to larger faster pertubation on a smaller or compliant surface
28
stepping strategy
response to strong pertubation, enough to displace COM outside Base of support
29
Sensory input and balance
Vison is affected by age and disease
Hearing loss
Vestibular function
proprioception
30
what happens with an elderly persons reaction time as their sensory input changes
as sensory information is decreased reaction time is significantly longer in older adults compared with young adults
31
Central processing
```
neurologic disease
Parkinsons
stroke
normal pressure hydrocephalus
dementia
depression- causes decreased concentration or awareness of potential environment hazards
```
32
MSK affecting balance
Muscle mass/strength no longer capable of generating the strength and accuracy of response to a balance disturbance
Weakness of hip abductors/adductors- decreased ability to maintain balance while stepping to avoid a fall
Osteoarthritis- pain deformity, limited range or motion, affect ability to beak impact of fall
foor problems- calluses, bunions affect sensory input
33
what happens to muscle strength as we age
strength declines with age for many adults
endurance decreases
muscle power is more highly correlated with physical function than muscle strength
Skeletal muscles loses both Type I&II fibers, number of motor units declines, number of myelinated fibers is reduced
34
what happens with range of motion as we age
spinal flexibility shows greatest decline with age compared with all other joints (spinal stenosis, throacic kyphosis etc)
Ankle joint flexibility, critical for postural control declines
Neuromuscular system contributes to postural control
35
Postural hypotension occurs in what percent of the elderly?
occurs in 10-30% of elderly community >65years old
36
what is postural hypotension defined
drop in systolic BP of 20mmHg or more with change in position from lying to standing
37
postural hypotension can be secondary to?
Meds
Dehydration
Age- associated with autonomic control of vasculature
38
bandura described self efficacy as what?
person’s perception of their ability to master a given type or level of performance in certain settings.
39
Tinetti decribed fear of falling as what?
as a diminished perceived self-efficacy at preventing a fall during normally non-hazardous activities of daily living.
40
reduced self-efficacy for balance/ fear of falling can lead to?
self imposed restrictions to activity
deconditioning and loss of muscle mass
decreased mobility
fall-related anxiety which leads to muscle tension
Fear of falling can predispose an individual to future falls without ever having experienced a fall
41
How do meds affects elderly's risk of falls
```
use of > 4 meds
impairs cognitive function
Electrolyte balance
BP
dizziness
fatigue
```
42
what meds put elderly patients at risk for falls
```
Anti-depressant
Diuretics
Neuroleptics/sedatives
Digoxin
Anti-arrhythmics
Sedative
Narcotic analgesics
Anti-HTN
```
43
measurement of balance confidence/ self efficacy
first attempts to measure fear of falling used dichotomous variable: are you afraid of falling? Yes/No
44
What does SAFE stand for
Survey of Activities and Fear of falling in Elderly.
| Multiple level of questions on specific activities
45
tools used to measurement of self-efficacy?
Falls Efficacy Scale (FES)
| Activities-specific balance confidence scale (ABC)
46
what is the ABC
Activities specific balance confidence scale
based on bandura's concept of self efficacy and task avoidance
developed by powell and myers for community dwelling older adults
required subjects to rate their confidence in completing 16 activities of daily living
47
ABC results/interpretation
overall confidence percentage is average of all 16 responses
-Scores 80% high functioning for active older adults
67% confidence level determined as falls risk with 84.4 sensitivity
48
benefits of ABC
provides insight into fear of falling syndrome
| facilitates active participation in interventions for falls risk reductions through acknowledgment of self-efficacy
49
ABC limitations
not appropriate for all setting as some activities may not have been experienced by participant
not a replacement for physical performance measures
50
what is the purpose of measurement of physical performance?
physical performance toll measures as person's risk for falls
developed around assessing normal functional tasks that require good balance
need to be easily administered, evidence based and clinically significant
51
what is the timed up and go (TUG)
developed as a measure of balance based on participants risk for falling
modified later to include timing and used to examine functional mobility in community dwelling, older adults 70-84 years of age
52
how is the Timed Up and Go measured?
time is taken to rise to stand up from a chair walk 3 meters, turn, walk back to chair and sit down.
53
TUG results/interpretation
older adults who take longer than 14 seconds have high risk of falls
other studies include TUG use in specific population/conditions
TUG score >16 seconds predicted falls in a 5yr period
TUG score of 24 or > for elderly persons post hip Fx valid predictor of fallin in the 1st 6 months after discharge
54
disadvantage of TUG
researchers have found instructions for speed, number of trails, seat height and cuing varies in literature
Timing should commence with command "GO" but researchers found inconsistencies
55
what is the Berg balance test
established by Berg as functional balance measure in geriatric patients
56
How does the Berg balance test preformed?
14 balance items rated by observer on 5 points ordinal scale for each item
Participant cannot use assistive devices
Requires 10-20min and only requires minimal equipment
(2 chairs- one with arm rests and one without, foot stool/step, stop watch, ruler)
Can be used in pts who can not ambulate
57
Benefits of berg balance test?
well known test: score may have meaning to multi-disciplinary team
may detect cognitive impairment because they may not be able to follow multi-step commands
valid measure in a variety of patient populations including stroke
looks at functional activities
low cost to administer
58
Berg balance test results
41-56
21-40
0-20
41-56 Independent
21-40 walking with assistance
0-20 wheelchair bound
59
What are multidisciplinary treatment in reducing risk factors for falling
Exercise/training to improve deficits in balance, mobility and strength
Correct sensory deficits (vision, hearing, vestibular, proprioceptive function)
Evaluate& Tx Hypotension
Review Meds
Treat foot problems
Environmental modification and use adaptive equipment
Education to patient and caretaker
60
what are intervention strategies?
address physical status with interventions to address strength, balance, gait
Wellness,med review, life modifications
ED/Tx of medical conditions
reduce home hazards
61
Interventions
```
Modify home environment
Minimize Meds
Manage Postural hypotension
Manage foot problems
Strength, balance, gait training
proper hydration & nutrition
```
62
How can fall risks be reduced
```
repair uneven pavement
install railings
keep shrubs trimmed
remove throw rugs
remove clutter
keep cords near walls
Emergency call device
Adequate lighting
Light switches at top and bottom of stairs
install grab bars in bath and near toilet
install raised toilet
use rubber matt in shower
do not use cupboards that are out of reach
```
63
learning to fall
key is relaxation
more likely to roll with impact
more likely to sustain least amount of injury
64
difficulty getting up after a fall
associated with substantial morbidity
51% of community dwelling elderly were unable to get up unassisted
85% of those who were not associated with serious injury
>20% remain on floor for >1hour
65
how to reduce risk of hospital falls/ nursing home falls
```
physical restraint
chemical restraint
bed alarms
call bell
low beds
arm bad to signify fall risk
Mats
scheduled toileting
use of assistive devices
```
66
evaluation of a patient who fell
```
unit personnel and healthcare providers are made aware in order to perform exam/tx
note associated symptoms
perform PE
Note any neuro findings or trauma
med review
lab or diagnostic studies
```
67
Osteoporosis
Osteoporosis increases an older person’s risk of fracture
A decrease of one standard deviation in femoral neck bone mineral density increases the risk of hip fracture 2.7 times
Low body mass index and low weight increase the force of impact with a fall b/c of lack of cushioning effect of muscle and subcutaneous tissue
