Week 12 Flashcards
An unexpected/unintentional event in which the person comes to rest on the ground, floor, or lower level
Fall
- Don’t have to fall onto the ground
- May occur as result of slip or trip e.g., slip and fall
Slip vs Trip
Slip: occurs when too little friction or traction between feet and the walking surface
Trip: Occurs when foot strikes an object or irregular surface and momentum throws you off balance
Why is it important to be consistent on which definition (trip, slip) you use with client?
- Keeping you and pt on same page is critical. What you call a fall may not be what a pt calls a fall
- Can give visualization as demonstration
- Whatever definition you choose, be consistent
T/F: Significantly more falls in community-dwelling OA compared to nursing home OA
False. Significantly higher fall rates in nursing homes
-Fall rates depend on the setting
What is the leading cause for:
- fatal injuries
- nonfatal injuries
- hospital admissions for trauma?
Falls. 2.2 million spent on fall issues related to ER visits annually
Of the following, which are the top 5 strongest risk factors for falls? A. Muscle weakness B. History of falls C. Balance deficits D. Use of AD E. visual deficits F. Arthritis G. Impaired ADL H. Depression I. Cognitive impairment J. Age>60 K. Gait deficits
B. History of falls G. Impaired ADL K. Gait deficits A. Muscle Weakness D. Use of AD -Surprisingly, not cognitive
The more fall risks one has, the more likely to…
Fall in an annual period. Linearly exponential
Outcomes of falls include…?
- Injuries (skin abrasions, bruises)
- Costs (ER visits)
- Loss of independence (maybe early admission to nursing home)
- Psychological trauma (fear of falling again)
- Death
How may a fall affect loss of independence in an OA?
May cause early admission to a nursing home
How may a fall cause psychological trauma in an OA?
They may have a fear of falling again
Hip fractures are often caused by …
falls
Who is more likely to fall and get a hip fracture–men or women?
Females more likely b/c osteoporosis
How does age affect the risk hip fractures from falling ?
Older=more likely to fall
- 85 and older much more likely to sustain hip fracture than 65
- 20% OA who sustain hip fracture from fall die in a year
Are older males or females more likely to sustain fatal injury from fall and hip fracture
- Males more likely to sustain fatal injury–die from fall
- Relates to infection post-fall
- Perhaps more riskier behaviors e.g., putting up christmas lights
Lasting concern about falling that can lead to an individual avoiding activities that he/she remains capable of performing
Fear of Falling (FOF)
Confidence or ability to avoid falls
Falls efficacy /falls self-efficacy
Focus on balance; how confident you are that you will be able to avoid loss of balance
Balance confidence
How afraid of falling you are
Fear of falling
All of the following except which are all possible consequences of FOF: A. Fall B. Decreased balance confidence C. Decreased QOL D. Anxiety E. Loss of appetite F. Depression G. Restricted activity H. Functional decline
E. Loss of appetite.
How may FOF cause depression?
Individual may be so afraid, they don’t want to leave house or engage in activities, so they have limited social circle
How may FOF cause a functional decline?
May have a fear of any movement, so don’t do as much
What is the AGS Fall Prevention Decision Guide?
- Tool when screening a pt
- How pt responds lets you know if you’re going to do a more elaborate tool
When using a fall screening tool like the AGS Fall Prevention Decision Guide, how do you know if you should do a more elaborate tool afterwards?
It pt reports fall in past year, do a more comprehensive assessment
Who should you do a fall prevention screen with?
Almost every OA!
Self-report vs. performance-based falls prevention assessments
With performance based, actually watching them do the activity
Screening vs. comprehensive assessments for fall prevention
Comprehensive: what you do after you screen for risk. Can be balance or confidence assessment
Examples of different areas of focus for fall prevention assessments…
Balance, functional mobility, home environment
How can we assess fall history retrospectively?
- Look at hospital admissions
- Ask pt (in the past X years/months/days, how many times have you had a fall BUT define fall first). Common time frame to ask is 12 months/1 year. But may say shorter time like 6 months if they’ve had a lot of falls since it’s hard to remember
- refer to chart that includes fall hisotry
How to assess fall history prospectively
Use fall diary/calendar
Why may using self-report to assess fall history be problematic
- May not be accurate
- May be afraid of the consequences if they say they’ve fallen e.g., may lose independence and go to nursing home
- Staff may not report if they feel they’ll get into trouble
What details should you find out about when looking at one’s fall history?
- Details about where they fell, context around fall
- Type of shoes
- If distraction occurring
- Drinking enough water (dehydration may cause low BP/orthostatic changes, so feel dizzy and fall)
- Get insight into their own falls (if person doesn’t tell us they understand why they fell, may be cognition or not paying attention–different ways to then direct tx)
What is the Timed up and go test (TUG)?
A gait and mobility assessment:
- Need arm chair
- When you say go, they get up and walk around 3 meter space and sit down
- Amt time to sit is outcome
- Can do it faster paced or ask them to hold cup of water to make harder
What is the Gait Speed test
Gait and mobility assessment:
- Put piece of tape on floor 4 m apart and mark on wall
- Ask them to start walking past line, don’t slow down
- Time takes to traverse certain amount of time is gait speed
- Easy to do in clinic-takes little time
- Don’t count first m because just getting started and gait hasn’t normalized
What is the 6-minute walk test?
Gait and mobility assessment:
- Amount distance person can travel for 6 minutes for 2 sets of cones
- Can see quality of walk change over time
What is the Tinetti Performance Oriented Mobility Assessment (POMA)?
Gait and mobility assessment
- Multiple tasks to do
- Have to push person unexpectedly
- Tests their rxn
- Have to be ready to catch them
What is the Dynamic Gait index
Gait and mobility assessment:
- Normal walking
- Talk while walking, head turning while walking
What are contextualized gait and mobility assessments?
- Watch walk into or out of room
- Watch walk to bathroom as ex
Balance test where you step out as far as you can and return to normal stance
Maximum step length. If they can’t return, then they have stepped out too far. A lot of people over and under shoot.
In the Max step length, who often overshoots?
Males and younger adults usually overshoot during max step length.
Balance test where you fix a ruler to the wall and they reach arm as far as they can without taking a step.
Functional reach test. The distance from where they start to end is functional reach.
30 sec balance test where you ask pt to stand on one foot (they may brace themself against wall).
Unipedal stance test. As soon as they put foot on ground, stop time.
30 sec balance tests where you ask pt to stand with one foot in line with another
Tandem stance test
With tandem and unipedal stance tests, what results would show that pt is at high risk, especially for injurious falls?
It pt can’t hold stance for 5 seconds
Balance test that looks at horizontal movement around pt’s BOS
Postural sway. More likely to research in lab than clinic Force plates pick up sway. Can challenge by pick up something, on one foot, close eyes. More sway, higher risk for falls
Balance test where pt stands up and down for 30 seconds
30 second chair stand
Balance test that requires 14 different balance tasks for pt to perform e.g., stand up from chair, stand on one foot
Berg Balance Scale. Usually done by PT
