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30 Cards in this Set
- Front
- Back
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How does the rate of falls in nursing homes and hospitals compare to the rate for community-dwelling persons?
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3 times the rate greater in nursing homes.
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What is the rank of unintentional injuries as a cause of death in older adults?
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5th
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What is responsible in 2/3 of the of the cases of death caused by unintentional injuries?
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falls
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What % of falls result in a serious injury?
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10%
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How does fall-related mortality for adults aged >65 compare to younger age groups?
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10 to 150 times greater.
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what % of fall deaths in the US occur in the 65+ population?
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72%
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Are most falls multifactorial or unifactorial?
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Multi, involving an interaction between long-term factors and short-term precipitating events.
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What are four intrinsic factors contributing to falls?
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Lower extremity weakness, balance disorders, functional and cognitive impairment, and visual defects.
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What are four extrinsic factors contributing to falls?
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Polypharmacy, lack of bathroom safety equipment, loose carpets, and poor lighting.
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What is the definition of polypharmacy?
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Greater than OR equal to 4 medications.
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11 risk factors for falls in order from greatest to least?
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Muscle weakness (4.4), History of falls (3.0), Gait deficit (2.9), Balance deficit (2.6), Use of assistive device (2.6), Visual deficit (2.5), arthritis (2.4), Impaired ADL (2.3), Depression (2.2), Cognitive impairment (1.8), Age > 80 (1.7).
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What is the annual fall risk for 0-1 of the 11 risk factors?
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10-27%.
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What is the annual fall risk for greater than or equal to 4 risk factors?
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69-78%
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What are four types of high-risk medications (and 3 types of the first type)?
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Psychotropic medications (Benzos, sedative-hypnotics, antipsychotics/antidepressants) (1.7), Class 1a antiarrythmic medications (1.6), Digoxin (1.2), Diuretics (1.1).
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What should we ask about in our hospitalized elderly patients, even if they have not presented with a fall complication?
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Falls
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Who should undergo a fall evaluation?
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presented to a medical facility because of a fall or complication. Have a history of recurrent falls. Have a history of a single fall and who demonstrate persistent gait/balance problems on examination or with PT. Have a fear of falling.
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Do restraints prevent falls? What do they do?
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No. In fact, they likely contribute to falls, injuries, and death from strangulation.
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8 assessments/risk factors for falls in elderly?
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Circumstances of previous falls. Medication use (high-risk medications or >/= 4 meds). Vision (acuity <20/60, decreased depth perception, decreased contrast sensitivity, cataracts). Postural blood pressure. ballance and gait. Targeted neurologic examination. Targeted musculoskeletal exam. Targeted cardiovascular eval. Home safety evaluation.
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What is the risk factor for medication use? The Management?
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High-risk medication or >/= 4 mediations. Review and reduction of medications.
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What is the management for circumstances of previous falls?
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Changes in environment and activity to reduce the lklelihood of recurrence.
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What is the risk factor for vision? The management?
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(acuity <20/60, decreased depth perception, decreased contrast sensitivity, cataracts). Ample lighting without glare, avoid multi-focal glasses when walking. Referral to an ophthalmologist.
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What is the risk factor for postural blood pressure?
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After >/= 5 min in supine position, immediately after standing, 2 minutes after standing. Review and reduction of medications, modify salt restriction, adequate hydration, compensatory teaching (rising slowly, HOB elevated), pressure stockings, ???pharmacologic therapy.
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What is the risk factor for balance and gait?
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Patient's report of observation of unsteadiness. Impairment on timed get-up and go test (TUG).
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What is the management for balance and gait?
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Reduction of medications that may impair balance. refer to PT for gait and balance training, assisteive devices.
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What is the risk factor for neurologic examination? The management?
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Impaired proprioception. Impaired cognition. Decreased muscle strenght. (Assistive devices or foot wear for increased proprioception, reduction of medications that impede cognition)
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What is the risk factor for musculolskeletal exam? (The management?)
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Exam of legs (joints, range of motion), exam of feet. (Referral for PT for strenght, range of motion, gait and and balance training. Use of appropriate footwear and referral to a odiatrist if needed. Referral for PT for gait, balance, and stregth training).
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What is the targeted cardiovascular eval looking for? (What is the management?)
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Looking for syncope. Carotid sinus massage, arrythmia w/u, referral to cardiologist.
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What is the management in a home safety evaluation?
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Removal of loose rugs, use of nightlights, non-slip bathmats, stair raiils, etc.
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What are four health-care based strategies shown in randomized controlled trials to be effective in reducing the occurrence of falls? (and what is their rates of risk rduction)
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Balance/gait training and strengthening exercises (14-27%). Reduction in home hazards after hospitalization (19%). Discontinuation of psychotropic medications (39%). Multifactorial risk assessment with targeted management (25-39%).
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What is one community-based strategy shown in randomized controlled trials to be effective in reducing the occurrence of falls?
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Specific balance or strenght exercise programs (29-49%)
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