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42 Cards in this Set
- Front
- Back
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what is the definition of "fall"
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an unintentional change in position that would not occur in an otherwise fit individual.
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how might an elderly person define falling?
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i think i slipped
i dont remember what happened i was in a hurry i tripped i lost my balance |
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true or false: false are the leading cause of accidental death in persons over the age of 65
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true
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what percentage of community dwelling persons 65 and older fall annually?
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30%
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how many pts that experience one fall will experience another?
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1/2
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what is a serious consequence of falls?
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hip fractures - leads to hospitalization
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when do most falls occur?
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during everyday activities
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Intrinsic risk factors
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-diseases/conditions that can lead to falls
-within themself |
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Extrinsic risk factors
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-related to environment
-can be indoors or outdoors -ice, snow, gravel, pot holes, etc |
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true or false: usually there is only one factor that caused a fall
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false: falls are multifactorial, usually w/ a combo of extrinsic and intrinsic factors
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what sensory changes occur in elderly that might contribute to falling?
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vision: decreased acuity, contrast sensitivity and depth perception, greater sensitivity to glare
proprioception: delayed sensory or motor input from muscle and joint receptors vestibular: impaired speech comprehension and reduced selectivity |
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what musculoskeletal changes occur in elderly that might contribute to falling?
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decline in muscle strength (esp lower extrem)
degeneration of cartilage in both hips and knees forward lean in posture, alters body's balance |
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what changes in gait might contribute to falling?
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decline in walking speed
increase in stride width decrease in steppage height loss of normal arm swing decrease in hip and knee rotation not all older adults have gait changes and certain characteristics might be preferred |
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what chronic diseases are related to falls?
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visual: cataracts, glaucoma
musculoskel: prolonged bedrest, immobility, OA, neuropathy, foot deformaties neuro: CVA, dementia (alzheimer's), parkinson's cardiovascular: orthostatic hypotension, syncope other: anxiety and depression |
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which acute diseases are associated w/ falls?
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CVA
SZR febrile conditions MI |
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which medications are associated w/ an increased risk of falls?
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analgesics and psychoactive drugs: reduce alertness or retard central processing
antihypertensives, antiarrhythmics, diuretics: impaired cerebral perfusion phenothiazines: induce EPS |
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what are some extrinsic risk factors concerning physical environment associated w/ falls?
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physical environment: clutter, slick/irregular floor surfaces, frayed carpets and throw rugs, lack of grab bars/rails, edges w/o contrasting color, curbs not clearly marked, poorly illuminated areas, armless chairs and low toilet seats
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what are some extrinsic factors concerning ambulation devices that are associated w/ falls?
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improper use
defective/faulty equipment |
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what are some extrinsic factors concerning footwear that are associated w/ falls?
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high-heels, slippers, improper fit
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what are three categories of extrinsic factors associated w/ falls?
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physical environment, ambulation devices, footwear
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what are four categories of intrinsic risk factors associated w/ falls?
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age-related physiologic changes, chronic dx, acute dx, drugs
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describe the screening process for falls. how often should pts be screened?
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no consensus about optimal time to initiate screening
ask about falls, as well as observe balance and gait at least YEARLY complete functional and risk assessment during the pt interview |
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describe the "up and go" test for gait and balance assessment
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task: get up out of standard armchair, walk 3 meters, turn, walk back to chair and sit down
requirement: ambulate w/ or w/o assistive devices and follow a three step command trials: one practice trial, three actual trials: times are averaged from tree trials time: 1-2 minutes equipment: armachair, stopwatch, measured path predictive results: <10s is freely mobile, <20s is mostly independent |
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what is the morse fall scale and how is it used?
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utilized in some inpt care settings, including hospital and long term care
complete on admission, after a change in condition, following a fall, or routinely |
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what are the item on the morse fall scale?
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hx of falling, immediate or w/in three months (no/yes)
secondary diagnosis (no/yes) ambulatory aid (bedrest,nurse assist/crutches,cane,walker/furniture) IV/Hep lock (no/yes) gait (normal, bedrest, immobile/weak/impaired) mental status (oriented to own ability/forgets limitations) |
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according to the morse scale, which scores are no risk, low risk, and high risk and what action is taken for each?
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no risk: 0-24, no action
low risk: 25-50 standard fall prevention strategies high risk: >51 high risk fall prevention strategies |
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when assessing a fall, what items are included for history?
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circumstances of fall (SPLATT) Syptoms Previous falls Location Activity Time Trauma
ask open ended ?s, ask witnesses ?s about circumstances medical problems medications (what meds do you take - Rx, OTC, herbal?, do you manage own meds or have help?, do you take your meds as the Dr prescribed? |
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when assessing a fall, what is measured during the physical exam
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postural blood pressure
mental status vision cardiac neuro musculoskeletal podiatry |
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what lab tests and imaging studies should be performed when assessing a fall?
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CBC and electrolytes
BUN and SCr CT or MRI |
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what fraction of falls result in injury that requires medical attention?
what percentage result in minor physical injury |
1 in 10 require medical attention
over 50% result in minor injury |
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Bladder dysfunction
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intrinsic factor
-nocturia -rushing to bathroom at risks of fall |
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what are some physical injuries associated w/ falls?
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distal forearm fracture (pain and decrease range of motion)
musculoskeletal injuries (sprains, joint dislocations, and skin tears) hip fractures (disabilities and nursing home placement rehabilitation services influence recovery) head trauma (EtOH is a factor in some cases, rule out subdural hematoma if mental confusion) |
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what types of complications are associated w/ falls?
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physical injury, long lies, restricted activity, psychological effects, health care costs
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what are some results of restricted activity following a fall?
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defecits in ADLs or IADLs
functional decline due to physical injury, fear of further falls or the environment |
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describe the psychological effects of falls
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depression, shame, anxiety, or loss of confidence may result; fear of falling may result in impaired gait and balance or loss of independence
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describe the impact of falls on health care costs
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direct and indirect costs involving the pt, caregiver and institution
increased utilization of health care services and their sequelae: ER visit, acute hospital admission, nursing home placement |
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what are some clinical management strategies for falls?
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medical, rehabilitative, injury prevention devices, environmental strategies, behavioral/psychosocial strategies
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describe the medical strategies in clinical management of falls
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treat concomitant medical problems, d/c inappropriate meds, consider Ca/Vit D supplements, d/c excessive EtOH consumption
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describe the rehab strategies in the clinical management of falls
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exercise: muscle stengthening, individualzied programs
ambulation devices: canes/walkers (use should be tailored for individual pt) wheelchairs consultants: PT, podiatric, opthalmic |
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name some injury prevention devices
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hip protectors/padding
emergency help systems |
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what are some environmental strategies in the prevention of falls
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home safety checklists, unobstructed clear pathways, lighting sources and access, slip resistant floor surfaces, handrails on stairs, shower seats and grab bars, proper bed and seat height, bed supports and rails
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what are some behavioral and psychosocial strategies in the clinical management of falls?
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pt education
social service referral increase person's confidence increase person's independence |
