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the knack of staying upright lecture covers in detail.

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https://geekymedics.com/falls/

10/10

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Improve Article 👀

Background

Those over the age of 65 have the highest risk of falling with 30% of those over 65 and 50% of those over 80 falling at least once a year.¹ Falls can have a profoundly negative impact on the quality of life of the elderly and their carers. The physical distress, pain and injury are also associated with loss of confidence and independence. This negatively affects morbidity and mortality with associated financial implications for the NHS.

History of Presenting Complaint

A detailed history is essential in determining the cause of falls. The table below highlights key information that should be gathered when taking a history.

WHO
Who has seen you fall?

Ensure adequate collateral history including addressing the when, where, what and why.

WHEN
When did you fall?

What time of day?

What were they doing at the time?

Looking upwards (vertebrobasilar insufficiency)

Getting up from bed (postural hypotension)

WHAT
What happened before/during and after the fall?

Was there any warning?

Was there any dizziness/chest pain or palpitations?

During

Was there any incontinence or tongue biting (indicating seizure activity).

Was there any loss of consciousness?

Was the patient pale/flushed (may indicate vasovagal attack)?

Did the patient injure themselves?

What part of the body had the first contact with the floor?

After

What happened after the fall?

Was the patient able to get themselves up off the floor?

How long did it take them?

Was the patient able to resume normal activities afterwards?

Was there any confusion after the event? (head injury)

Was there any weakness or speech difficulty after the event? (e.g. stroke/TIA)

WHY
Why do you think you fell?

May have tripped over a rug or started a new medication.

HOW
How many times have you fallen over the last 6 months?

Allows you to gauge the severity of the problem.

Be cautious in cases where the patient is unable to recall events clearly, as this may indicate new confusion associated with a head injury.

Systems Enquiry

A systems enquiry may identify other relevant information that may relate to falls.

Past Medical History

Social History

Alcohol intake

Support at home - friends/family and carers

Mobility - use of mobility aids and when (e.g. zimmer frame downstairs only)

Medication review

Most medications have side effects which can increase the likelihood of falls. Polypharmacy itself is a risk factor for falls. It is good practice to review medications and de-prescribe those which are no-longer indicated.

Beta-blockers (bradycardia)

Diabetic medications (hypoglycaemia)

Antihypertensives (hypotension)

Benzodiazepines (sedation)

Antibiotics (intercurrent infection)

Clinical Examination

Investigations

Investigations are based on your history and examination but could include some of those mentioned below.

Differential Diagnosis

The differential diagnosis of falls is very broad. It is important to determine whether the patient has suffered a transient loss of consciousness or a simple mechanical fall.

Some possible causes of falls are shown in the table below.

Management

Once a transient loss of consciousness event has been ruled out, it is important to complete a full falls risk assessment. This is indicated in order to identify any causative features especially as older people are likely to have multiple co-existing risk factors. Although priority should be to treat any underlying medical cause (e.g. pacemaker if complete heart block), all causes should be addressed where possible. Due to the complex aetiology, it is important to continue to search for possible risk factors and causes of falls even when one has been found.

The table below includes some of the key components of a full falls risk assessment.

References

Falls in older people: assessing risk and prevention. Clinical guideline [CG161]. Published date:

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Falls - Assessment, Investigation & Management

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Improve Article 👀 Those over the age of 65 have the highest risk of falling with 30% of those over 65 and 50% of those over 80 falling at least once a year.¹ Falls can have a profoundly negative impact on the quality of life of the elderly and their carers.

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https://www.who.int/news-room/fact-sheets/detail/ageing-and-health

Good article

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Key facts on ageing and health: explanation of ageing, common health conditions associated with ageing, Factors influencing Healthy Ageing, Challenges in responding to population ageing and WHO’s response

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https://geekymedics.com/falls/
Good summary of the LO

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Improve Article 👀

Background

Those over the age of 65 have the highest risk of falling with 30% of those over 65 and 50% of those over 80 falling at least once a year.¹ Falls can have a profoundly negative impact on the quality of life of the elderly and their carers. The physical distress, pain and injury are also associated with loss of confidence and independence. This negatively affects morbidity and mortality with associated financial implications for the NHS.

History of Presenting Complaint

A detailed history is essential in determining the cause of falls. The table below highlights key information that should be gathered when taking a history.

WHO
Who has seen you fall?

Ensure adequate collateral history including addressing the when, where, what and why.

WHEN
When did you fall?

What time of day?

What were they doing at the time?

Looking upwards (vertebrobasilar insufficiency)

Getting up from bed (postural hypotension)

WHAT
What happened before/during and after the fall?

Was there any warning?

Was there any dizziness/chest pain or palpitations?

During

Was there any incontinence or tongue biting (indicating seizure activity).

Was there any loss of consciousness?

Was the patient pale/flushed (may indicate vasovagal attack)?

Did the patient injure themselves?

What part of the body had the first contact with the floor?

After

What happened after the fall?

Was the patient able to get themselves up off the floor?

How long did it take them?

Was the patient able to resume normal activities afterwards?

Was there any confusion after the event? (head injury)

Was there any weakness or speech difficulty after the event? (e.g. stroke/TIA)

WHY
Why do you think you fell?

May have tripped over a rug or started a new medication.

HOW
How many times have you fallen over the last 6 months?

Allows you to gauge the severity of the problem.

Be cautious in cases where the patient is unable to recall events clearly, as this may indicate new confusion associated with a head injury.

Systems Enquiry

A systems enquiry may identify other relevant information that may relate to falls.

Past Medical History

Social History

Alcohol intake

Support at home - friends/family and carers

Mobility - use of mobility aids and when (e.g. zimmer frame downstairs only)

Medication review

Most medications have side effects which can increase the likelihood of falls. Polypharmacy itself is a risk factor for falls. It is good practice to review medications and de-prescribe those which are no-longer indicated.

Beta-blockers (bradycardia)

Diabetic medications (hypoglycaemia)

Antihypertensives (hypotension)

Benzodiazepines (sedation)

Antibiotics (intercurrent infection)

Clinical Examination

Investigations

Investigations are based on your history and examination but could include some of those mentioned below.

Differential Diagnosis

The differential diagnosis of falls is very broad. It is important to determine whether the patient has suffered a transient loss of consciousness or a simple mechanical fall.

Some possible causes of falls are shown in the table below.

Management

Once a transient loss of consciousness event has been ruled out, it is important to complete a full falls risk assessment. This is indicated in order to identify any causative features especially as older people are likely to have multiple co-existing risk factors. Although priority should be to treat any underlying medical cause (e.g. pacemaker if complete heart block), all causes should be addressed where possible. Due to the complex aetiology, it is important to continue to search for possible risk factors and causes of falls even when one has been found.

The table below includes some of the key components of a full falls risk assessment.

References

Falls in older people: assessing risk and prevention. Clinical guideline [CG161]. Published date:

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Falls - Assessment, Investigation & Management

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Improve Article 👀 Those over the age of 65 have the highest risk of falling with 30% of those over 65 and 50% of those over 80 falling at least once a year.¹ Falls can have a profoundly negative impact on the quality of life of the elderly and their carers.

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This LO is covered next week.

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Lee, S. (2022) The knack of staying upright and what can go wrong as you get older. Delivered 3 May 2022.
This lecture discussed in detail why people might fall - vestibular conditions, eye conditions.
Mathu's link provides everything we need to know.

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Fiddes, T. (2022) Home assessment in the falling patient. Delivered 3 May 2022.
Lots of detail in this lecture for this LO. It decribes the criteria for those deemed to be at high-risk from falling, as well as hazards in the home, e.g. poor lighting, steps not marked, rugs.

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Straughan, L. (2022) PT and OT for older people. Delivered 3 May 2022.
Thacker, H. and Anka, A. (2022) Social work and older people. Delivered 3 May 2022.
The first lecture discussed the role of the OT, PT and SLT in assessing the care needs of older people. The second lecture discussed the role of social workers in assessing the care needs of older people. Both of these lectures covered the LO well.

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Straughan, L. (2022) PT and OT for older people. Delivered 3 May 2022.
This lecture covered the consequences of admitting someone to hospital only.

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Fiddes, T. (2022) Home assessment in the falling patient. Delivered 3 May 2022.
One slide from this lecture (image already attached) had all the information we need for this LO. No lecture as such on this LO.

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Lee, S. (2022) The knack of staying upright and what can go wrong as you get older. Delivered 3 May 2022.
The second half of this lecture covered the reasons in detail why older people fall, e.g. medications, polypharmacy, certain medical conditions.

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Straughan, L. (2022) PT and OT for older people. Delivered 3 May 2022.
One slide from this lecture (image already attached) had all the information we need for this LO.

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Susan Lee - "The Knack of Staying Upright and what can go wrong when we are older" lecture

Vision changes - reduced depth perception, reduced contrast sensitivity
Gait changes, compensatory reflexes are slower (~20 seconds)
Brain has fewer nerve fibres and fewer neutrons, therefore slower rxn times

Diseases affecting balance
- cataracts
- macular degeneration
- bifocals
- vertigo
- parkinsons
- stroke

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https://www.clinicalkey.com/student/content/book/3-s2.0-B9780702070280000329#hl0000939 - covers the LO well.

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From the ‘home assessment and the patient LO

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OT assessment -

Assessment & consideration  of:
• Impact  of medical  conditions
• Self care (toileting,  nutrition,
washing  and dressing)
• Transfers and  mobility
• Domestic activities
• Cognitive status
• Falls screening
• Support  networks
• Leisure time
• Assessment  & preparation  for
discharge

PT assessment

Assessment includes:
◼ subjective factors – identifies patient concerns and expressed needs
◼ objective factors – function in ADL ( activities of daily living), mobility,
strength
◼ environmental factors – physical space ◼ carer/relatives factors – needs, beliefs and attitudes
❑ mental status of client
❑ function – transfers, sit to stand, turning, balance, stairs, steps, in and out of car
❑ mobility and strength – observation and recorded measures ❑ space, risks
❑ footwear
❑ carer – proven skills for handling, motivation etc.

SLT assessment

◼ Informal assessment
❑ e.g. observations; conversational skills; sensory or
cognitive impairment; screening for swallowing difficulties
abilities; swallow function – video fluoroscopy
◼ Formal assessment of function
❑ e.g. components of speech production; language ◼ → profile of strengths and difficulties

Social workers assessment

What is the role of  social work with older people
• Care Act 2014 – assessment and eligibility
determination
• Risk assessment
• Mental Capacity/Best interest assessment
• Safeguarding – including self-neglect
• Community work
• Involving older people, their carers and families in
their care
• Anti-discriminatory and anti oppressive practice

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'The knack of staying upright and what can go wrong as you get older' - Clinical Lecture

The lecture covers the LO
Mathu has summarised the key points well

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This is covered by the clinical lecture ‘home assessment and the falling patient’.

Targeting resources
- High risk fallers Fallen before in previous 12 months
- Fall with injury
- Cognitive impairment
- Visual impairment
- Gait or balance impairment
- Fear of falling
- Leaving a rehab setting particularly post fracture neck of femur

Purpose of home assessment with people who fall

Identify home hazards and recommend or arrange modifications

Assess and modify performance and function

Identify and agree strategies to reduce falls risk

Education and information giving

Completing the home visit
 Standardised assessment process e.g home fast checklist that OT can use
 Clinical reasoning
 Observation of function and behaviour
 Activity analysis

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This is covered in next weeks LO.

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The lecture PT, OT & SLT for older people covered the disadvantages/consequences of hospital admission but advantages are not covered.

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The lecture PT, OT & SLT for older people covered this LO well.

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Pretty sure it's next week's lecture

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PT/OT/SLT lecture
Good disadvantages of older people being admitted into hospital
Advantages should be common sense (Better access to emergency care/Better treatment options/Difficult conditions can be managed/ etc.)

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Clinical Lecture: The knack of staying upright and what can go wrong as you get older

Yassin and Joe summarised the key points well

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PT/OT/SLT -Clinical Lecture
Covered this LO

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PT, OT and SLT - Clinical Lecture

Covered this LO well

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PT, OT and SLT - Clinical Lecture

Covered this LO well

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The Physiology of Normal Ageing

This is covered in next weeks lecture.

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Eye sight gets worse
Hearing problems
Heart problems
Neurological problems
Musculoskeletal problems

Generally as we age the above factors gets worse which increases the risk of falls

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PT, OT, SLT lecture covered this well

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In video it is shown how the entire house must be considered from the garden, living room, stairs and bathtub. Shows the things which are done well and the common risk factors - cables, slippery surface, loose fitting carpet.

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The University of Vermont Medical Center

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Clinical Lecture: The knack of staying upright and what can go wrong as you get older

Older people generally have more health problems e.g. heart diseases, diabetes, neural problems

Eye problems
Ear problems
Neural problems
Drugs -> polypharmacy

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PT, OT and SLT lecture coved this L.O well.

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‘The Clinical Lecture: The knack of staying upright and what can go wrong as you get older’ covered this LO well.

Condition that causes increase falls:

Eye - Catracts, macular degeneration, bifocals

Vestibular - Benign paroxysmal positional vertigo and Ménière’s disease

Brain - Parkinson, stroke

Nerve muscle - neuropathy and myopathy

Cervical spondylosis, OA, foot deformity (e.g diabetes with peripheral central neuropathy)

Drug classAdverse reaction

NSAIDs  | Gastrointestinal bleeding and peptic ulceration Renal impairment
Diuretics  | Renal impairment, electrolyte disturbance Gout Hypotension, postural hypotension
Warfarin  | Bleeding
ACE inhibitors  | Renal impairment, electrolyte disturbance Hypotension, postural hypotension
β-blockers  | Bradycardia, heart block Hypotension, postural hypotension
Opiates  | Constipation, vomiting Delirium Urinary retention
Antidepressants  | Delirium Hyponatraemia (SSRIs) Hypotension, postural hypotension Falls
Benzodiazepines  | Delirium Falls
Anticholinergics  | Delirium Urinary retention Constipation

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This slide of the lecture covered this entire LO.

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Deterioration, higher readmission rates, higher use of long term care, inability to do ADL, reduced mobility, reduced confidence.

These were all listed as the disadvantages of admitting the elderly to hospital - lecture didn't seem to cover the advantages.

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Reduced contrast sensitivity, reduced dark adaption

Polypharmacy

Comorbidities - COPD, dementia, DM, HTN, heart disease

Fewer neurons, fewer neurons, reduced reaction times

Reduced muscle mass and strength

Increased sway and stooped posture

Cataracts, bifocal lenses and maculopathy

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Louise Straughan: Clinical Lecture

PT, OT and SLT for older people

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Louise Straughan: Clinical Lecture

PT, OT and SLT for older people

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PT, OT, SLT, for older people falls lecture covered how different roles in MDT contributed to preventing falls in elderly e.g.

OT: promote function, qual of life, motivate

PT: movement and exercise, manual tehrapy, eductaion advice

SLT: speech, language, communication or swallowing difficulty

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PT, OT, SLT for older people falls lecture gives good overview