Elderly Fall Risk Assessment

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Questions and Answers

Which factor is NOT considered a risk factor for falls?

Timed up and go test performance greater than 20 seconds

History of falls greater than 2

High visual acuity (correct)

Tinetti test score less than 20 points

Which statement about mobility evaluation is correct?

A sit to stand difficulty is irrelevant in mobility assessment.

Reduced walking speed does not impact physical capacity.

Reduced dynamic balance is a sign of good mobility.

Gait dysfunction is a significant indicator of mobility issues. (correct)

What is considered a high pathology risk associated with mobility impairment?

Reduction in grip strength

Dementia (correct)

Lack of cardiovascular issues

Excessive flexibility in joints

Which of the following conditions is linked to high deficits in physical function?

Parkinson's disease Signup and view all the answers

Which of these medications contributes to an increased risk of falls?

Sedatives and hypnotics Signup and view all the answers

Which of the following factors does NOT contribute to sarcopenia in the elderly?

Increased muscle strength Signup and view all the answers

What is a significant physiological change associated with ageing that impacts balance and fall risk?

Reduced reaction time Signup and view all the answers

Which strategy is NOT considered effective for preventing falls in the elderly?

Increased solitude Signup and view all the answers

What is the relationship between age and the risk of falls in the elderly population?

Age does not strictly determine fall risk Signup and view all the answers

Which of the following best describes intrinsic factors that can lead to falls in the elderly?

Reduced physical strength Signup and view all the answers

What is an intrinsic risk factor in falls risk assessment?

History of previous falls Signup and view all the answers

Which of the following is a recommended strategy for a frail individual living at home?

Standardized geriatric assessment Signup and view all the answers

What is a key component of a personalized multifactorial intervention for fall prevention?

Medication prescription adaptation Signup and view all the answers

How is low muscle strength typically assessed?

Using grip strength tests Signup and view all the answers

Which exercise approach is recommended for improving gait and balance?

Combined exercise prescription including gait and balance training Signup and view all the answers

What is considered a common strategy for individuals dependent and living in institutions?

Addressing polypathology assessment Signup and view all the answers

Which of the following best describes the recommendation for physical activity in frailty assessment?

At least 150 minutes of moderate activity per week Signup and view all the answers

What should be included in a falls risk assessment?

Balance and gait evaluation Signup and view all the answers

Which of the following is NOT a focus of assessment for a good health stage?

Manage chronic illnesses Signup and view all the answers

What is an example of an extrinsic risk factor for falls?

Poorly lit areas in home Signup and view all the answers

Study Notes

Assessment and Exercise Prescription for Geriatric Population

This topic focuses on assessment and exercise prescription for elderly patients.

Lecture Outline

Challenges and consequences of falls in the elderly
Physiological reminders of aging
Risk factors for falls
Intrinsic factors
Extrinsic factors
Strategies for preventing falls
Scientific validity of prevention strategies
Lifestyle advice
Exercise therapy

Introduction

When are we considered "old"?
What is aging?

What is Aging?

Accumulation of molecular and cellular damage over time
No difference between the process of "aging" and degenerative processes
Age is a poor indicator of the changes
Associated with life transitions (retirement, housing adaptations, death of relatives)

Additional Aspects of Aging

Reduced reaction time
Gait impairment
Reduced adaptive strategies
Difficulties in double tasks
Reduced perception of obstacles and light adaptation
Balance impairment
Sarcopenia
Hormonal changes (sleep, growth factor, osteoporosis)

Sarcopenia

Loss of muscle mass, quality, and strength linked with aging
Measured at 4-6% per decade(women starting ~40, men ~60)
Correlates with physical impairment, quality of life, and death
Precipitated by poor diet, physical inactivity, comorbidities (more than two diseases at a same time), genetic factors, hormones, neuromuscular dysfunction, & trauma

Frailty

Risk of falling not strictly related to age; relates to frailty
Conjunction of multiple interacting conditions
It's an unavoidable process
Difficult subclinical elements unobservable during clinical exam
Assessed via functional scales
Four major components: muscle function, balance and walking function, cognitive function, and nutritional status
Operational definition via 5 areas: mobility, physical impairment, sensory ability, memory, energy
Dependency is not the only expression of frailty: less than 20% of frail individuals are dependent
Not correlated with gender, region of residence, marital status, or age; correlated with socioeconomic level
Energy is the most commonly affected area
No typical elderly: health inequalities and stereotypes
Rapidly changing world

What is Falling?

Event where a person unintentionally lands on a lower level
Excludes loss of consciousness, stroke, and significant external events

Consequences of Falling

Leads to significant and lasting functional deterioration, even without severe trauma
Reveals frailty
Decreases ability to respond to external disturbances
Increases frailty process
Relapse is more than 50% within a year
Reflects maladjustment to the environment; influenced by many factors
Approximately 20% result in medical interventions
Approximately 10% result in fractures (hip, vertebra, wrist)

Post-Falls Syndrome

Fear of falling comes before the fall
Psychomotor maladjustment
Spontaneous reduction in activity
Decreased functional abilities
Postural or gait disorders
Increased risk of further falls

Predictive Factors

Multifactorial
Aging
Pathology affecting equilibrium function
Medication
Environment
Behaviour (Intrinsic factors)
Do not prioritize individuals at high risk of serious injury
Extrinsic factors: environment, behaviour, activities

Extrinsic Factors

Behavioural: alcohol, sedentary lifestyle, nutrition
Risk-taking: vigorous older people (20-40%) fall (22% vs 6% frail)
Environmental: objects on ground, poor lighting, slippery/uneven ground, steps, chairs, bed height; relevance of hazards is important, not just number

Example of Fall Prevention Strategies

Illustration showing adjustments to a living space to prevent falls

Intrinsic Factors

Demographics: age > 80 correlates with reduction in ADL, reduced mobility
Pathology: Parkinson's, dementia, incontinence
Musculoskeletal factors: reduction in knee/hip/ankle/grip strength; gait dysfunction, reduced walking speed; altered dynamic balance; sit-to-stand difficulty
Sensory factors: reduced visual acuity
Cognitive factors: Mini Mental State; Depression
Medication: sedative, hypnotic, anxiolytic, >4 medications

Recurrence Factors

History of falls > 2
Time spent on ground > 3 hours
Tinetti test score <20 points
Timed up & go test >20 seconds
Unipodal hold <5 seconds
Impaired postural adaptation reactions
Stopping walking when asked

Prevention

Medical appointment for fall history
Risk factor assessment (history, previous falls, intrinsic/extrinsic risk factors, gait/balance quick test, neurological assessment, cardiovascular assessment)
Personalized multifactorial intervention
Exercise prescription (gait, balance)
Medication adaptation
Environmental adaptation

Strategies

Different phases of health and living situations (good health, frail, dependent living) with corresponding assessment and specific/common strategies, detailed in a table format

Assessing Frailty

Fried's criteria:
Physical inactivity (less than 150 minutes moderate activity per week)
Low muscle strength (grip strength <21 kgf for men, <14 kg for women)
Slow walking speed (less than 0.8 m/s)
Exhaustion/fatigue
Weight loss (4.5kg, or 5% of body weight)
Scoring: 0-1 = not frail; 1-2 = pre-frail; 3+ = frail (mild, moderate, severe)

Assessing Frailty - What to Assess

Muscle function (grip strength, chair lift)
Balance and walk function (Timed Up & Go, 6-minute walk test, Tinetti, unipodal balance)
Cognitive functions (Mini Mental State, CODEX, Geriatric Depression Scale)
Nutritional status (Nutritional Screening Initiative)
Dependency (Katz: Activity of Daily Living, IADL: Instrumental Activity of Daily Living)

Assessing Dependency

Assessing dependency is a constant concern for geriatricians
Functional assessment is used to describe the elderly person's performance in basic activities of daily living (ADLs)
Dependency refers to the need for a third party to assist in these activities
ADL - Katz Questionnaire for measuring functional status; assesses 6 functions (bathing, dressing, toileting, transferring, continence, feeding)
Score 1 or 0 per question

Assessing Nutritional Status

Malnutrition has consequences.
Questioning allows initial screening
Refrigerator inspection for out-of-date items indicates difficulties managing the diet
5% weight loss over 1 year is a predictor of increased mortality
Low albumin levels (<35g/L) increased mortality (5.3 times higher)
Hypoalbuminemia and hypocholesterolemia increase risk of decline/mortality

Assessing Cognitive Status

Detailed information on the Mini Mental State Examination (MMSE) including questions asked and scoring

Exercise Prescription for Osteoporosis

Weight-bearing exercises (walking, dancing, stair climbing, hiking)
Resistance training (squats, lunges, seated rows)
Balance exercises (one-leg stands, tandem walking, heel-to-toe walking)
Postural exercises (to address kyphosis and vertebral fractures)
Gradual increase in exercises' intensity, duration, and complexity

Exercise Prescription for Sarcopenia

Resistance training (rows, leg presses, chest presses, bicep curls)
Aerobic exercises (walking, cycling, swimming)
Balance and functional exercises (single-leg stances, tandem walking, chair stands, step-ups)
Flexibility exercises (stretching)
Gradual increase in intensity, duration, and complexity

Exergames

Project promoting fall risk prevention in seniors in Luxembourg
Video game use for improving balance
Participants report high satisfaction with the physical enjoyment component, some uncertainty about independent use at home

Otago Home Exercise Program

Study specifically designed for falls prevention, with strengthening, balance, and walking exercises
Moderate intensity exercise

Community Exercises

Exercises for improving balance and flexibility focused on many activities (dancing, gym sessions, group exercises, home exercise programs, lawn bowling/boules/pétanque, Pilates, Tai Chi, yoga, hydrotherapy).

Fall Management - Rehab Plan Reasoning

Uni-factorial interventions(strength training, balance exercises) are effective reducing falls in home-living people.
Multiple factors (multi-factorial interventions) are needed in high-risk or frail individuals
Important key muscles for balance include dorsal flexors of feet, triceps surae, quads, hamstrings
Balance training is essential
Physical activity maintains the elderly person's autonomy, preferably individual, targeted, and adapted to the person

Fall Management - Balance

Sensory input (vestibular, visual, proprioceptive input) is integrated.
This integrated input leads to motor output to control body adjustments
Key organs for balance include the vestibular system, cerebellum, cerebral cortex, and brainstem.

Fall Management - Strengthening

Account for fatigue
Focus on key muscles (ankle, dorsiflexors, triceps, quads, hamstrings)
Use 60-80% of 1RM
Use closed chain exercises
Aim for lower energy cost and functional movements.

Fall Management - Foot

Important sensory input
Gait (ROM: Ankle, feet, muscle length, triceps surae)
External sensory stimulation
Weight-bearing proprioceptive exercises

Fall Management - Addressing Fear

Progressive exposure to feared situations is used; gradual increase in difficulty
Individualised exercise program is designed for the specific circumstances (desensitization)

Fall Management - Optimizing Sensory Afferents

Exercises on foam cushions or mats/seated exercises with balls/unstable trays.
Progression in difficulty for sensory training (reducing support, oscillations, eye closure etc)

Fall Management - Optokinetic Examples

Exercises that focus on cervical spine ROM/eye-head dissociation/egocentric and exocentric targets/walking + eye-head dissociation

Fall Management - Exocentric

Focus is on external objects/targets.
Visual and spatial information is used to interact with external environment.
Examples include ball sports, target-based activities, and interactive activities (partner/opponent interaction)

Fall Management - Egocentric

Focus is on body movements, positioning, and spatial orientation.
Proprioceptive and kinesthetic information is important for maintaining balance and coordination.

Fall Management - Walking Rehabilitation

Footwear modifications
Adapting aids
Speed changes/walking phases
Walking on uneven surfaces
Positional changes/standing balance
Obstacle negotiation

Fall Management - Getting Up After Falling

Detailed steps and instructions (visual aids provided) are presented

Exercise Prescription for Osteoporosis Exercise Prescription for Sarcopenia

Details on specific exercises, and targeting muscles, for better posture, strength, balance, and function

References

A comprehensive list of publications and web resources related to the topic.

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Description

This quiz assesses your understanding of the risk factors associated with falls in the elderly population and the implications of mobility impairment. Explore key physiological changes, intrinsic factors, and prevention strategies that can help mitigate these risks. Test your knowledge about falls and aging in this comprehensive quiz!