falls
Terms
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- Categories of intrinsic risk factors
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1)Age-related physiologic changes
2)Chronic diseases
3)Acute diseases
4)Medications - Age-related physiologic changes
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1)sensory
-decreased visual acuity
2)musculoskeletal
-decline in muscle strength
3)Gait - Chronic diseases
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1)visual
-cataracts,glaucoma
2)musculoskeletal
-osteoarthritis, neuropathies
3)neurological
-CVA,dementia,parkinson's
4)cardiovascular
-orthostatic hypotension, recurrent syncope
5)anxiety and depression - Acute diseases
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1)CVA
2)MI
3)Seizures
4)febrile conditions -
Medications
1)reduce alertness or retard central processing
2)impair cerebral perfusion
3)induce extrapyramidal effects -
1)analgesics, psychoactives
2)antihypertensives, antiarrhythmics,diuretics
3)phenothiazines - Categories of extrinsic risk factors
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1)physical environment
2)ambulation devices
3)footwear - physical environment examples
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1)environmental clutter
2)lack of grab bars/rails
3)armless chairs and low toilet seats - Up and Go Test
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1)get out of standard armchair, walk 3 mters turn, walk back to chair and sit down
2)<10s is freely mobile, <20s is mostly independent - Items measured in the Morse Fall scale
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1)hx of falling; immediate or w/in 3 months
2)secondary diagnosis
3)ambulatory aid
4)IV/Heparin Lock
5)Gait
6)mental status - Fall assessment
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1)circumstances of fall
-"SPLATT" (symptoms, previous falls, location, activity, time, trauma)
2)medical problems
3)medications
4)physical examination
-BP, mental status, vision, cardiac, neurologic, musculoskeletal, podiatry
5)lab and imaging studies
-CBC, electrolytes, BUN, Cr, CT/MRI - Complications of falls
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1)phsyical injury
-distal forearm fracture
-musculoskeletal injuries
-hip fractures
-head trauma
2)long lies
-dehydration, pressure sores, rhabdomyolysis
3)restricted activity
4)psychological effects
5)health care costs - Medical strategies in management of falls
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1)treat concomitant medical problems
2)d/c inappropriate meds
3)calcium/vit D supplement
4)d/c excessive alcohol use - Rehabilitative strategies
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1)exercise
-strengthen muscle groups
2)ambulation devices
-canes, walkers, wheelchairs
3)consultants
-PT, podiatric service, Ophthalmic exam - Environmental Strategies
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1)home safety checklists
2)unobstructed pathways
3)bed supports and bed rails
4)lighting sources and access - Behavioral/Psychosocial strategies
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1)patient education
2)social service referral
3)increase person's confidence
4)increase person's independence