Learn about the causes and prevention of falls in this 46-minute physician grand rounds presentation by Dr. Michael Kitchell, a neurologist at McFarland Clinic. Explore the serious consequences of falls, the importance of prevention over treatment, and quality measurement in fall prevention. Examine inpatient falls, common gait disorders, and the proper workup for patients with balance issues. Discover the connection between vitamin B12 deficiency and balance problems, and understand various neurological causes of falls, including Parkinson's disease, frailty, and other conditions. Investigate the multiple causes of dizziness and how to differentiate between them. Gain practical knowledge on fall prevention strategies, including exercise programs, medication reviews, and vision testing. Understand the significance of fall history as a predictor of future falls and the increased risk associated with frailty. Learn when to refer patients with gait disorders to neurology and physical therapy for further evaluation and treatment.
Overview
Syllabus
Intro
Causes and Prevention of Falls
Bad things happen when you fall
Prevention, not treatment is better
Quality Measurement
Inpatient falls. difficult to prevent
Gait disorders: Common as we a Half of patients 85 yearst need cane or walker Workup of patients: History of balance trouble, falls, "dizziness" Exam: walking, tandem gait, Romberg, ortho BP, proprioceptive sensation MRI for younger and more rapid onset in older patients Vitamin B12 deficiency is commonly associated with balance trouble Diagnosis needed but if workup is negative, call it "gait disorder"
Parkinson's disease Not all Parkinson's patients have tremor Gait is slow, with postural instability Shuffling, trouble arising and initiating gait Loss of associated movement: reduced arm swing, leaning, stiff posture Slow AMR, rigidity in trunk and/or extremities
Frailty: frequent cause of falling Definition: "condition of being weak and delicate" Age is a risk factor, but age is not always predictive of frailty Age 65-74: 27% reported falls, age 85+: 37% reported falls Frailty is often avoidable if the person is motivated to stay active, exercise
Other neurologic causes Progressive supranuclear palsy-often fall on stairs (slow eye movement, voice and swallow trouble) Multiple system atrophy (Shy Drager): parkinsonian features with autonomic failure, orthostatic hypotension Corticobasal degeneration (dystonic limbs and trunk, often unilateral) Strokes: in basal ganglia, cerebellar pathways, lacunar state with multiple strokes
Dizziness: multiple causes Dizziness is often a vague symptom, needs further evaluation Is it intermittent, triggered by movement (positional vertigo)? Is it just a feeling of lightheadedness? (Could be anxiety or meds) Some patients with balance/equilibrium problems present with "dizziness" The exam with galt, tandem, Romberg, orthostatic blood pressure helps to differentiate
How to prevent falls Exercise program Review medications: sleep meds, muscle relaxers, antidepressants, antipsychotics, etc. Vision testing yearly
Summary: History of falls is simple tool to detect risk of another fall (with injury) Frailty increases risk of faling with injury Medication, ortho blood pressures need to be checked Refer patients with gait disorders to neurology, PT
Taught by
Mary Greeley Medical Center
