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Yr3 Specialities > Elderly Falls > Flashcards

Elderly Falls Flashcards

1
Q

Define a fall

A

Inadvertently coming to rest on ground/lower level WITHOUT loss of consciousness and other than as a consequence of sudden paralysis, seizure, alcohol or overwhelming physical force

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2
Q

What are the risk factors for a fall?

A 
H/o
Muscle weakness
Gait or balance deficit
Use of assistive device
Visual deficit
Arthritis
Depression or cognitive impairment
>80yrs
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3
Q

What intrinsic factors (aka disorders) could cause a fall?

A 
Chronic neuro/MSK disease
Visual problems
Acute illness e.g. UTI, chest infection
Cognitive disorders e.g. dementia or delirium
Syncope
Gait/balance problems
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4
Q

simply Postural Instability is the biggest cause of falls in the elderly, how would we asses a patient’s gait and balance to see if they’re at risk of such a fall?

A 
Sit -> Stand ability
Static standing balance & Romberg test
Dynamic standing balance
Gait
Berg balance scale
Timed get up and go test (TUG)
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5
Q

What is a TUG test?

A

Timed get Up and Go (TUG)

The patient is timed for how long it takes them to stand from a chair, walk 10 feet then come back and sit down

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6
Q

Other than Postural Instability, can you think of another balance issue that would cause a lot of falls in the elderly?

A

Vertigo! Particularly BPPV

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7
Q

Think of possible causes for syncope

A
  • Vasovagal
  • Carotid sinus hypersensitivity
  • Situational
  • Orthostatic hypotension
  • Cardiac arrythmias
  • Structural cardiopulm disease
  • Cerebrovascular events
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8
Q

Thinking about the elderly, what could cause “Situational” syncope?

A

Some people get it post-micturition, post-exercise or on defecation

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9
Q

What are the most common causes of orthostatic hypotension?

A

Drug (prescribed) induced autonomic failure

Volume depletion due to haemorrhage or diarrhoea

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10
Q

Think of some structural cardiac or cardiopulm disorders that could cause syncope?

A

Acute MI
PE
Valvular disease

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11
Q

Someone has an episode of syncope, what would you want to know?

A
  • Any prodromal symptoms?
  • Loss of consciousness? Last & first things they recall
  • H/o
  • Injuries
  • PMH & FH
  • Meds
  • 3rd party (appearance, movements, tongue-biting, duration and confusion/weakness in recovery)
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12
Q

How would you examine someone who’s had syncope?

A

Standing & lying BP
NEuro & CV exam
look for injuries

Also do an ECG

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13
Q

When assessing a patient with syncope what would be red-flag symptoms?

A
  • Certain ECG abnormalities
  • Heart failure symptoms/signs
  • Onset with exertion
  • F/h sudden cardiac deathj
  • New/unexplained SOB
  • Murmur
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14
Q

What signs would suggest syncope might actually have been a seizure?

A 
Bitten tongue
Head turning to one side
Abnormal behaviour with no memory
Unusual posture
Prolonged jerking
Confusion afterward
Prodromal Deja vu
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15
Q

We’ve covered intrinsic factors contributing to falls. What situational factors could trigger a fall?

A
  • Some meds e.g. antidepressants, anti-hypertensives, anti-muscarinics and diuretics
  • Alcohol
  • Urgency to micturate
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16
Q

What extrinsic factors contribute to falls?

A

Footwear
Poor lighting
Unfamiliar environments
Environmental hazards like uneven paving or stairs

17
Q

Who is involved in the MDT assessing falls or fall risk elderly patients

A

Geriatrician
Nursing
Phsyio
OT

18
Q

A major danger for elderly people at risk of falls is fractures, particularly with Osteoporosis. How do we screen for osteoporosis?

A

FRAX or QFRACTURE tools to assess risk.

If fracture risk is >10% at 10yrs we test BMD using DEXA scanning

19
Q

How do we treat someone with osteoporosis to reduce fracture risk?

A
  • Ca/VitD supplements
  • Bisphosphonates
  • Teriparatide
  • Denosumab
20
Q

How do the various Osteoporosis drugs work?

A

Bisphosphonates - induce apoptosis in osteoclasts
Teriparatide - PTH analogue
Denosumab - Osteoclast inhibitor

21
Q

How can we manage a falls patient?

A

If possible treat the cause e.g. acute infection or arrythmia
Home hazard & Safety intervention
Strength & balance training
Medication review
Cardiac pacing for Carotid sinus hypersensitivity

22
Q

Define Sarcopenia

A

Degenerative loss of skeletal muscle mass, quality and strength associated with aging.
A key component of “Frailty syndrome”

23
Q

What are the common contributing factors to Sarcopenia>

A

DECLINE

Diabetes
Elderly
Chronic Disease
Lack of use
Inflammation
Nutritional Deficiency
Endocrine dysfunction

Yr3 Specialities (16 decks)

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