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CC March 2017 Falls in the Elderly

rename
echoecho's version from 2018-04-12 04:02

Section

Question Answer
One-third of community-dwelling individuals over the age of ____ will experience at least one fall annually, often causing significant injury such as a fracture or closed head injury? 65
Injuries may be serious enough to warrant _______ or emergency surgery and may even lead to death?hospitalization
Preventing falls and subsequent injuries has become increasingly important in the _______ population?elderly
List the risk factors of falls?1) advancing age 2) a hx of falls 3) impaired mobility 4)gait and balance issues 5) weakness 6) dizziness 7) postural hypotension 8) vision impairment 9) cognitive impairment 10) sedating medications 11) alcohol consumption
What is the most effective means of preventing falls and injury-related falls in the elderly?1) careful screening 2) risk stratification
The CDC has developed an algorithm to screen for fall risk and to determine appropriate intervention. The process begins with completion of the _______ questionnaire and evaluation of gait, balance and strength issues?STEADI
What does STEADI stand for?Stopping Elderly Accidents, Deaths and Injury
memorize
List the questions on the STEADI questionnaire with scoring as to a "yes" answer and why it matters
Question Answer
Yes (2) No (0) I have fallen in the past year?Why it matters = people who have fallen once are likely to fall again
Yes (2) No (0) I use or have been advised to use a cane or walker to get around safely?Why it matters = people who have been advised to use a cane or walker may already be more likely to fall
Yes (1) No (0) Sometimes I feel unsteady when I am walking?Why it matters = unsteadiness or needing support while walking are signs of poor balance
Yes (1) No (0) I steady myself by holding on to furniture while walking at home?Why it matters = this is also a sign of poor balance
Yes (1) No (0) I am worried about falling?Why it matters = People who are worried about falling are more likely to fall
Yes (1) No (0) I need to push with my hands to stand up from a chair?Why it matters = This is a sign of weak leg muscle, a major reason for falling
Yes (1) No (0) I have some trouble stepping up onto a curb?Why it matters = This is also a sign of weak leg muscles
Yes (1) No (0) I often have to rush to the toilet?Why it matters = Rushing to the bathroom, especially at night, increases your chance of falling
Yes (1) No (0) I have lost some feeling in my feet?Why this matters = Numbness in your feet can cause stumbles and leads to falls
Yes (1) No (0) I take medicine that sometimes makes me feel light-headed or more tired than usual?Why this matters = Side effects from medicines can sometimes increase your chance of falling
Yes (1) No (0) I take medicine to help me sleep or improve my mood?Why this matters = These medicines can sometimes increase your chance of falling
Yes (1) No (0) I often feel sad or depressed?Why this matters = Symptoms of depression, such as not feeling well or feeling slowed down, are linked to falls
How is the STEADI questionnaire scored?Add up the number of points for each yes answer. If one score > 4 points, the patient may be at risk for falling
List the algorithm for fall risk assessment and intervention for a LOW RISK PATIENT?Pt completes Stay Independent brochure. Screen for falls and/or fall risk by asking 3 questions (1)fell in past year, if yes ask how many times and were you injured (2) feels unsteady when standing or walking (3) worries about falling, if NO to all key questions, educate patient (recommend vit D and calcium and refer for strength and balance exercise (community exercise or fall prevention program)
Next on the algorithm if patient answered YES to any of the 3 questions (1) fell in past year, if yes how many times and were you injured?. (2) feels unsteady when standing or walking (3) worries about falling? Evaluate gait, strength and balance by using the following tests: 1) Timed UP & GO (recommended) 2) 30 second chair stand (optional) 3) 4 stage balance test (optional)
If patient passes all three tests, there is no gait, strength or balance problems, so what to tell patient?Educate patient. Vit D, Calcium. Refer for strength and balance exercise (community exercise or fall prevention programs
If the patient does not pass any of the three tests, there is a gait, strength or balance problem. If there is 0 falls, what is the patient a risk for?MODERATE RISK. Educate pt. and review and modify medications. Vit D and calcium. Refer to PT to improve gait, strength and balance OR refer to a community fall prevention program
If the patient does not pass any of the three tests, there is a gait, strength or balance problem. If there is 1 fall without injury, what is the patient a risk for?MODERATE RISK. Educate pt. and review and modify medications. Vit D and calcium. Refer to PT to improve gait, strength and balance OR refer to a community fall prevention program
If the patient does not pass any of the three tests, there is a gait, strength or balance problem. If there is 1 fall WITH injury or more than 2 falls, what is the patient a risk for?1) conduct multifactorial risk assessment (review Stay Independent brochure. Falls history. Physical exam including = postural dizziness/postural hypotension. Medication review. Cognitive screen. Feet and footwear. Use of mobility aids. Visual acuity check. 2) HIGH RISK (educate patients, vit D and calcium, refer to PT to enhance functional mobility and improve strength and balance. Manage and monitor hypotension. Modify medications. Address foot problems, optimize vision. Optimize home safety. 3) follow-up with HIGH RISK patients w/in 30 days (review care plan; assess and encourage fall risk reduction behaviors, discuss and address barriers to adherence. Transition to maintenance exercise program when patient is ready.
How is the Timed Up and Go (TUG) test done?have the patient get up from a chair and walk 10 feet (the pt may use a walking aid), turn around and return to the chair. If an individual requires > 12 seconds to complete the test, he is at an increased risk of falling
Tug test results are predictive of falls primarily in _____, __________ patients?frail institutionalized
Patients who report a recent fall, feel unsteady or have a fear of falls should be screened with what test?TUG test
How is the 30 second chair stand test done and what does it test for?1) repeatedly stand from a seated position without using their arms for assistance 2) tests for leg strength and endurance
How is the 4-stage balance test done and what does it test for?1) stand with feet centered together, feet together slightly of center, in tandem and on one foot in 10 seconds
Based on results of the TUG tests or other tests, interventions may be recommended to reduce what?incidence of future falls and injuries (balance and/or strengthening exercises, referral for physical therapy or home assessment to reduce fall risks (identify loose carpet, poor lighting))
*** The USPSTF recommends exercise to prevent falls in community-dwelling adults age _____ or older who are at increased risk of falls?65
Patients at high-risk of falls may also be screened for what disease?osteoporosis
Patients taking anticoagulants should have what evaluated?their need for anticoagulation
The latest USPSTF draft recommends against prescribing vit ___ for fall prevention?D
What is often prescribed based on risk but are not considered universal interventions to reduce falls in all elderly patients, the frail elderly may benefit most?exercise and physical therapy
Is there definite evidence regarding the benefit from the use of hip protectors?no
The Morse Fall Scale is used int the _______ setting to help identify patients at risk of a fall?inpatient
What may patients at risk for falls in the hospital benefit from that can identify fall risks, increased assistance when getting out of the bed and formal physical therapy evaluation and treatment?environmental scans
*** SUMMARY = True or false. Falls in the elderly are common and can result in serious injury?true
*** SUMMARY = Falls are associated with what risk factors?1) advancing age 2) hx of falls 3) impaired mobility an balance 4) postural hypotension 5) vision impairment 6) sedating medications
*** SUMMARY = What test can be used to identify patients at risk?the Time Up and Go (TUG) test
*** SUMMARY = What interventions may lower the risk of subsequent falls?1) exercise 2) physical therapy
memorize