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Published on : Aug 06, 2021 | Views : 3811 | Downloads : 8

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Slide 1-

Falls in the Elderly Nazia Mumtaz & Sairah Naeem GPST3’s in General Practice
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Aims and objectives Epidemiology Risk assessment Falls assessment Primary prevention Secondary prevention What NICE does/doesn’t recommend Patient education How to refer for falls assessment
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Epidemiology The leading cause of mortality resulting from injury in people aged > 75 years 400,000 older people attend A&E each year for falls 14000 die due to osteoporotic hip fractures each year 1 in 3 people > 65 years fall at least once per year 1 in 2 people >80 years fall at least once per year 5% of these need hospitalisation (Royal society for the Prevention of Accidents)
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Initial assessment History- how, ?LOC, injuries, pain, loss of function, headache, carers re behaviour, long lie Examination- temperature, MMSE, bruising, reduced function, confusion, postural BP, pulse, neurology, fundi, vision testing Investigation- risk factors, bloods (FBC, U&Es, LFTs, TFTs, Vitamin B12, glucose), urinalysis, ECG, ECHO, specialist assessment (optician, neuroimaging etc) Treat- fractures- Colles’/NOF, subdural haematoma, pneumonia, hypothermia, UTI, dehydration
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management Referral: A&E- significant HI, ?fracture, other injuries- lacerations Acute elderly admission- acute medical cause, unable to cope Outpatient referral elderly- unclear cause recurrent falls, possibility of further falls, not coping well
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What is a falls assessment? Falls history Gait, balance, mobility, muscle weakness Osteoporosis risk Perceived functional ability Fear of falling, perceived functional ability Visual impairment Cognitive impairment Neurological exam Continence Home hazards Cardiovascular exam Medication review
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Key point Falls are usually MULTIFACTORIAL
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Risk factors Previous falls Female 2:1 in >75 years Age > 80 years Disorders of gait/balance/co-ordination Visual impairment Cognitive impairment/confusion Low morale/depression High level of dependency with ADLs Reduced mobility Foot problems/inappropriate footwear Arthritis Lower limb weakness Stroke/Parkinson’s Polypharmacy Alcohol Environmental factors Infection Use of walking aids, e.g. Walking stick
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Environmental Loose rugs/electric leads Wet surfaces- spills, bathroom Poor lighting Ice High winds Use of ladders Too low/too high- chair/bed
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Neurological problems Stroke Parkinson’s- abnormal posture, freezing, frontal impairment, poor leaning balance, leg weakness Neuropathy- diabetes Proximal myopathy e.g. thyrotoxicosis, Cushing’s syndrome- esp rising from sitting Cognitive impairment
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LOC Syncope seizures Dizziness Arrythmias Tachyarhythmias- broad/narrow complex tachycardias Bradycardias AF
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Drop attacks Cardiovascular Carotid sinus disease TIAs Orthostatic hypotension
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medications Psychotropic drugs- phenothiazines, tricyclic antidepressants Levodopa Bromocriptine Sedatives Diuretics Betablockers ACE inhibitors Alpha blockers Diabetic medications- insulin, sulphonylureas
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Key point Rule out possibility of elder abuse
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Secondary prevention -what we have just done
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Primary prevention-
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Identification Ask elderly people routinely whether they have fallen in last year Older people reporting a fall or considered at risk of falling
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tests Timed up and go test- ‘rise from chair without support of arms, walk 3 metres, turn around and sit again’. (NB- can use walking stick. Look for unsteadiness/difficulty) Turn 180’ test-’stand up and step around until facing the opposite direction’. (NB- further assessment if >4 steps needed)
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INTERVENTIONS What is available???????????
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What is effective? *Multicomponent programmes According to NICE: Strength and balance training (Tai Chi) Home hazard assessment and intervention Medication review Cardiac pacing as indicated Visual assessment and referral
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Not recommended by NICE Not at all- brisk walking Insufficient evidence- low intensity exercise + incontinence programmes group exercise cognitive/behavioural interventions referral for correction of visual impairment on its own vitamin D hip protectors
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education How to cope with a fall What changes are they willing to make? Motivation/fear of falling Measures to prevent falls Preventable nature of some falls Physical/psychological benefits of modifying risk Further advice and assistance
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Raising awareness Falls awareness week (Age UK:18-22 June 2012- http://www.ageuk.org.uk)
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Nsf for the elderly Standard 6: Establishment of MDTs to deal with management of falls
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How to refer for falls assessment Through district nurses Falls clinics Multidisciplinary falls teams
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AKT question Which of the following, on their own, is recommended by the NICE 2004 guidelines on the assessment and prevention of falls as an intervention? Brisk walking Referral for correction of visual impairment Cardiac pacing Group exercise Hip protectors
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References Patient.co.uk. Prevention of falls in the elderly:http://www.patient.co.uk/doctor/Prevention-of-Falls-in-the-Elderly.htm NICE clinical guideline 21: The assessment and prevention of falls in older people, November 2004. http://www.nice.org.uk/CG021 Simon C, Everitt H, Van Dorp F. Oxford handbook of general practice, 3rd ed. Oxford. 2010. p210