HCE - Falls

HCE - Falls • Give the incidence of falls in the older population. 15-30% in community population (increases with increasing age) • List the common risk factors for falls Female Age >80rs Muscle weakness Gait / Balance problem Visual Defect Arthritis Depression Cognitive impairment • Describe the impact of falls on the elderly population Morbidity & Mortality (50% result in injury, 5% result in #) Institutionalisation Quality of Life Fear of falling à social isolation à less exercise à more falls • Be able to describe the key elements of the balance system (input, output, central processing, external factors) as a homeostatic system. Intrinsic Factors Homeostatic BP (should adjust from sat à stood, can fail naturally / iatrogenic) Cerebellum (walking patterns become less efficient & more irregular) Vision (deteriorates with age) Proprioception (deteriorates with age, and with DM etc) Inner ear Reaction time (decreases with age) Sway (increases with age, greater in women) Nutritional (often poor in elderly) Strength (decreases if limited exercise) • Be able to list common diseases and impairments contributing to lack of homeostatic reserve of the balance system, and common challenges to the system. Impaired sensory input Visual impairment (cateracts, glaucoma, poor glasses) – hazard detection worsens Impaired hearing and balance (inc vertigo & dizziness) Peripheral neuropathy makes walking more difficult Medication (Iatrogenic – e.g. postural hypotension) Sedative such as benzodiazepine / opiates (drowsy + impair eye sight & balance) Postural hypotension – e.g. due to diuretics or treatment of PD Cardiac arrythmias may be iatrogenic (2o to TCAs) Neuroleptic mediations can have extrapramidal SEs Anti-arrhythmics (digoxin) Anti-hypertensives (affect electrolyte and ion balance à drop BP) Alcohol Gait abnormality Parkinsons Hemiplegic gait Cerebellar disease Sensory Ataxia Normal pressure hydrocephalus Antalgic gait (painful joint) Proximal myopathy Scissoring gait Foot drop Reduced cerebral perfusion Cardiac TIA Syncope Epilepsy Can be preceeded by “burning smell” (temporal lobe epilepsy) Dizziness / Unsteadiness Vascular – will respond to aspirin Cervical spondylitis – may improve if neck collar worn Review & stop any implicated meds Psychiatric Problems Dementia (esp lewy body) Delerium Depression Psych medication (inc antipsychotics and antidepressants) Extrinsic (environment) Carpet, lighting, stairs, pets Unsuitable footwear - slippers If in hospital – ward design, restraints, staff attitude • Be able to list multiple simple interventions that could reverse or ameliorate the above diseases and impairments or reduce environmental challenge. Regular review of medications Identify and treat any cause (e.g. cardiac pacing) Strength & Balance training (physio) Home hazards assessment (occupational therapy) Bone densitometry (calcium, Vit D, Bisphosphonates, Raloxifene (selective oestrogen receptor modulator – used in post menopausal women) Fall prevention program – often at day centres Arrange alarm system Teach patients how to get up from the floor without help