Why are falls more important in elderly patients?
- They are more likely to get an injury
- More likely to suffer a fracture
- Mortality rates are higher
- More likely to end up in a nursing home
What other comorbidities can result from immobility after a fall?
- Hypothermia
- Dehydration
- Pressure sores
- Rhabdomyolysis
- DVT
- Pneumonia
Women fall more often that men. TRUE/FALSE?
TRUE
Patients who are in hospitals or long term care fall more often. TRUE/FALSE?
TRUE
50% fall per year
What body systems need to be engaged for a patient to be able to walk/stand safely?
Neuro - motor co-ordination
Senses - vision and vestibular system for balance
MSK - joint stability/ muscle strength
What physiological parts of ageing make older people more likely to have a fall?
- Vision: smaller pupils, lens thickening=↓light
- Sarcopenia
- ↓Peripheral sensation and proprioception
- ↓Cardiorespiratory fitness
- ↓reaction time
Elderly patients tend to have multiple chronic conditions. Which of these can cause a fall?
- Cardiovascular disease/syncope
- Cognitive impairment
- Neurological
- Vestibular disease
- Vision problems
- Musculoskeletal/gait
Describe a fall due to syncope?
- Pt goes pale and sweaty
- Falls suddenly and is down for a couple of minutes
- Is confused for a further few minutes
- Then returns to normal
What are the common causes of falls due to syncope?
Arrythmias Orthostatic hypotension Neurogenic (vasovagal) Carotid sinus hypersensitivity Valvular heart disease (Aortic stenosis)
What is the definition of orthostatic hypotension?
Fall in SBP >20 mmHg or
Fall in DBP >10 mmHg after 3 minutes of standing
Why does a cognitive impairment increase a patients risk of falls?
Cognitive Impairment worsens:
- Judgement
- Visual-spatial perception
- Orientation
What neurological conditions may contribute to an increased risk of falls?
Cervical myelopathy Peripheral neuropathy Lumbar stenosis Cerebellar ataxia Parkinson’s disease
ALL CONDITIONS ALTER GAIT => more likely to fall
Why are patients with Parkinson’s more likely to suffer a fall (aside from the altered gait)?
Susceptible to orthostatic hypotension
What vestibular disease can often cause people to fall due to “dizziness” or “vertigo”?
Benign Paroxysmal Positional Vertigo:
How is BPPV confirmed and managed in patients?
Confirm with Dix-Hallpike manoeuvre
treated with Epley manoeuvre = better balance
What common visual problems can increase fall risk?
Cataracts
Bi-focal/varifocal lenses - these alter patients depth perception
What external factors can cause patients to fall?
Medication Alcohol Environmental hazards (e.g. clutter in house) Inappropriate clothing/footwear Inappropriate walking aids
What environments make elderly patients more prone to falling?
- Clutter
- Rugs
- Poor lighting
- No hand rails
- Stairs
Polypharmacy increases the risk of patients falling. TRUE/FALSE?
TRUE
≥4 meds independent falls risk factor
WHat specific drug classes increase patients risk of falls?
Benzodiazepines Neuroleptics Antihypertensives Antidepressants Anticholinergics Class 1A anti-arrhythmics
How do we screen for falls?
Ask any patients:
- Have you had 2 or more falls in last 12 months?
- Have you presented acutely with a fall?
- Do you have problems with walking or balance?
What examinations and clinical assessments must be carried out after a patient has had a fall?
ABCDE Neurological Gait, balance, joints Feet and footwear CVS Visual acuity
How is a lying and standing BP taken?
1st BP: taken after lying for at least 5 mins
2nd BP: taken after standing in the 1st min
3rd BP: taken after standing for 3 mins
note any symptoms felt during
Describe the “Timed up and Go” Test
Pt is asked to stand up from chair and walk 3 metres before turning round and returning to sitting in the chair
A time over 12 seconds indicates slow movement
