Download Free Medical Falls in the Elderly PowerPoint Presentation

Falls in the Elderly PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on Emergency Medical Services (EMS), which is titled "Falls in the Elderly", to know about Falls in the Elderly.

Tags : Emergency Medical Services, EMS, Falls, Elderly

Published on : Aug 06, 2021 | Views : 3441 | Downloads : 8

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Falls in the Elderly Nazia Mumtaz & Sairah Naeem GPST3’s in General Practice
Slide 2-

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
Slide 3-

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)
Slide 4-

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
Slide 5-

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
Slide 6-

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
Slide 7-

Key point Falls are usually MULTIFACTORIAL
Slide 8-

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
Slide 9-

Environmental Loose rugs/electric leads Wet surfaces- spills, bathroom Poor lighting Ice High winds Use of ladders Too low/too high- chair/bed
Slide 10-

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
Slide 11-

LOC Syncope seizures Dizziness Arrythmias Tachyarhythmias- broad/narrow complex tachycardias Bradycardias AF
Slide 12-

Drop attacks Cardiovascular Carotid sinus disease TIAs Orthostatic hypotension
Slide 13-

medications Psychotropic drugs- phenothiazines, tricyclic antidepressants Levodopa Bromocriptine Sedatives Diuretics Betablockers ACE inhibitors Alpha blockers Diabetic medications- insulin, sulphonylureas
Slide 14-

Key point Rule out possibility of elder abuse
Slide 15-

Secondary prevention -what we have just done
Slide 16-

Primary prevention-
Slide 17-

Identification Ask elderly people routinely whether they have fallen in last year Older people reporting a fall or considered at risk of falling
Slide 18-

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)
Slide 19-

INTERVENTIONS What is available???????????
Slide 20-

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
Slide 21-

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
Slide 22-

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
Slide 23-

Raising awareness Falls awareness week (Age UK:18-22 June 2012- http://www.ageuk.org.uk)
Slide 24-

Nsf for the elderly Standard 6: Establishment of MDTs to deal with management of falls
Slide 25-

How to refer for falls assessment Through district nurses Falls clinics Multidisciplinary falls teams
Slide 26-

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
Slide 27-

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