Falls - Block 4

Question 1

Describe the progressions to falls?

Answer 1

Fraility -> falls -> debility

Question 2

Wha are the potential complications for falls?

Answer 2

1. SOft tissue injury
2. Fractures
3. Subdural hematoma
4. Hospitalization
5. Limited mobility

Question 3

What are intrinsic RF for falls?

Answer 3

1. Medical and neurological conditions, sensory impairment
2. Age related changes in NM function, reflexes, and gait

Question 4

What is the difference between older men and women walks?

Answer 4

Men: wide-based, short stepped gaits
Women: narrow-based, waddling gait

Question 5

What are extrinsic RF for falling?

Answer 5

1. Medications
2. Improper footwear or use of assistive devices
3. Environmental hazards

Question 6

What are meds that contribute to fall risk?

Answer 6

• Antihypertensives/ alpha-blockers -> bradycardia/hypotension
• Antidepressants -> postural hypotension
• Cholinesterase inhibitors -> bradycardia
• Diuretics -> hypovolemia
• Sedatives -> sedation
• Antipsychotics -> sedation, muscle rigidity, postural hypotension
• Hypoglycemics -> acute hypoglycemia
• Alcohol -> acute intoxication

Question 7

What are examples of improper footwear?

Answer 7

Older adults have lower arches and increased circumference of foot unit

Narrow or small shoes: Pain
Loose shoes: lower gait speed, shorter stride length, irregular gait pattern

Question 8

What are the goals for assistive devices?

Answer 8

Improve independent mobility, reduce disability, delay functional decline, and decrease the burden of care

Question 9

What are the types of assistive devices?

Answer 9

1. Canes (standard, offset, quadripod)
2. Crutches (axillary, forearm, platform)
3. Walkers (standard, front-wheeled, four-wheeled)

Question 10

What are the difficulties of using assistive devices?

Answer 10

1. Lifting and advancing the device -> destabilization
2. Need to allocate attention to control device -> disrupts balance
3. Interference with limb movements
4. Repetitive stress on upper extremity joints -> tendinopathy, OA, carpal tunnenl

Question 11

How do we determine what walking device we use?

Answer 11

Question 12

What are the environmental hazards of using assistive devices?

Answer 12

1. Slippery surfaces
2. Inadequate lighting
3. Loose, deep pile, or worn carpets
4. Staircases without railings
5. Unsupportive or badly arranged furniture
6. Poorly designed tubs, toilets, and fixtures in the bathroom
7. Clutter
8. Pets underfoot

Question 13

WHat are the behavioral RF?

Answer 13

1. Performing behaviors that could increase fall risk
2. Not performing behaviors that could reduce fall risk
3. Selecting unsafe clothing, footwear, or inappropriate or outdated eyewear prescriptions

Question 14

What are the core elements for fall prevention?

Answer 14

1. Screen
2. Assess
3. Intervene

Question 15

How do we help others prevent falls?

Answer 15

1. Adaptation or modification of home environment
2. Withdrawal or minimization of psychoactive medications
3. Withdrawal or minimization of other medications
4. Management of postural hypotension, urinary frequency/urgency, vitamin D deficiency
5. Management of foot problems/footwear, visual impairment
6. Exercise, particularly balance, strength, and gait training
7. Increase caution or awareness and reduce other high-risk behaviors

Question 16

How do we modify the home to prevent falls?

Answer 16

1. Removing hazards
2. Adding special features or assistive devices
3. Moving furnishings
4. Changing places where activities occur
5. Renovating rooms to accomodate disabilities

Question 17

What are tools used to assess falls at home?

Answer 17

**Checklist: **
* Check for Safety: A Home Fall Prevention Checklist for Older Adults
* Westmead Home Safety Assessment (WeHSA)

Functional fall risk assessment:
* Conducted by health care or social service professionals
* Falls Home Assessment
* Comprehensive Assessment and Solution Process for Aging Residents

Question 18

What are the characterizations of fraility and debility?

Answer 18

High risk of severe illness, falls, malnutrition, and death
* Low physical activity
* Muscle weakness
* Slowed performance
* Fatigue or poor endurance
* Unintentional weight loss

Question 19

What are the common medical ADR?

Answer 19

Musculoskeletal -> arthritis, osteoporosis
Neurological -> stroke, PD
Cardiovascular -> HF, PVD
Pulmonary -> COPD
Others -> pain, motivation, mood, fear

Question 20

What are the assessment tools for fraility?

Answer 20

Questionnaires:
Frail Elderly Functional Questionnaire
Groningen Frailty Indicator
Tilburg Frailty Indicator

Assessments:
Edmonton Frail Scale
Comprehensive geriatric assessment

Question 21

How do you manage fraility and debility?

Answer 21

1. Exercise (physical and mental)
2. Treatment of underlying health issues
3. Healthy diet