NURS 5461 GERIATRIC SYNDROMES EXAM QUESTIONS AND
ANSWERS WITH COMPLETE SOLUTIONS VERIFIED LATEST
UPDATE
FALLS
1 in 3 adults ≥ 65 years reports falling each year
One-half of those > 80 years • One-half of nursing-home residents • Nearly 60% of
those with history of falls • Complications of falls are the leading cause of death from
injury in people aged ≥65 years
MORBIDITY AND MORTALITY
Most falls by older adults result in some injury • 5%-10% of falls by older adults result in
fracture or more serious soft-tissue injury or head trauma • The death rate attributable to
falls increases with age • Mortality highest in white men aged ≥85: >180 deaths/100,000
population
Associated with:
Decline in functional status Nursing home placement Increased use of medical services
Fear of falling • Half of those who fall are unable to get up without help ("long lie") • A
"long lie" predicts lasting decline in functional status
CAUSES OF FALLS BY OLDER ADULTS
Rarely due to a single cause • May be due to the accumulated effect of multiple
impairments (similar to other geriatric syndromes) • Complex interaction of: Intrinsic
,factors (e.g., chronic disease) Challenges to postural control (e.g., changing position)
Mediating factors (e.g., risk taking, situational hazards
INTRINSIC RISK FACTORS
• Older age • Cognitive impairment • Female gender • Past history of a fall • Leg
weakness or gait problems • Foot disorders • Balance problems • Hypovitaminosis D •
Pain • Parkinson's disease • Stroke • Arthritis
Age-related decline
Changes in visual function Proprioceptive system, vestibular system Regulation of
systolic blood pressure Reduced total body water, risk of dehydration with stressors
Chronic disease
Parkinson's disease Strokes Osteoarthritis, chronic pain
CAUSES: MEDICATION USE
Benzodiazepines Other sedatives Antidepressants Antipsychotic drugs Cardiac
medications Hypoglycemic agents • Recent medication dosage adjustments • Total
number of medications
CLINICAL GUIDELINES
Ask all older adults about falls in past year • Single fall: check for balance or gait
disturbance • Recurrent falls or gait or balance disturbance: Pursue a multifactorial falls
risk assessment
FALL HISTORY
History of falls Activity at time of fall(s) Prodromal symptoms Location and time of fall(s)
Medication history (new, changed, high-risk meds)
• Lighting • Floor coverings • Railings • Furniture • Door thresholds • Footwear
, PHYSICAL EXAMINATION
The most important part includes an assessment of integrated musculoskeletal function
Functional reach test
yardstick test <6in =high risk
Up and Go test (with or without timing)
get up s arm support walk 3m, then sit back down without using arms if >15s =in risk
Berg Balance Test
15 measures incl picking anoject up off the floor
Performance-Oriented Mobility Assessment (POMA)
abnl if 1 pt off for two or more items, or 1.5 off for a single item.
LABORATORY & DIAGNOSTIC TESTING
Tests and procedures should be guided by the history & physical exam:
echocardiography, brain imaging, radiographic studies of spine • Hemoglobin, BUN,
creatinine, glucose: can exclude anemia, dehydration, or hyperglycemia • Holter
monitoring: no proven value for routine evaluation • Carotid sinus massage with
continuous heart rate and BP monitoring is advocated by some for pts with unexplained
falls: can uncover carotid sinus hypersensitivity
FALLS PREVENTION GUIDELINES
Prescribe exercise, particularly balance, strength, and gait training Discontinue or
minimize psychoactive and other medications Manage postural hypotension Manage
foot problems and footwear Supplement vitamin D Treat vision impairment Manage
heart rate and rhythm abnormalities Modify the home environment
TREATMENT
ANSWERS WITH COMPLETE SOLUTIONS VERIFIED LATEST
UPDATE
FALLS
1 in 3 adults ≥ 65 years reports falling each year
One-half of those > 80 years • One-half of nursing-home residents • Nearly 60% of
those with history of falls • Complications of falls are the leading cause of death from
injury in people aged ≥65 years
MORBIDITY AND MORTALITY
Most falls by older adults result in some injury • 5%-10% of falls by older adults result in
fracture or more serious soft-tissue injury or head trauma • The death rate attributable to
falls increases with age • Mortality highest in white men aged ≥85: >180 deaths/100,000
population
Associated with:
Decline in functional status Nursing home placement Increased use of medical services
Fear of falling • Half of those who fall are unable to get up without help ("long lie") • A
"long lie" predicts lasting decline in functional status
CAUSES OF FALLS BY OLDER ADULTS
Rarely due to a single cause • May be due to the accumulated effect of multiple
impairments (similar to other geriatric syndromes) • Complex interaction of: Intrinsic
,factors (e.g., chronic disease) Challenges to postural control (e.g., changing position)
Mediating factors (e.g., risk taking, situational hazards
INTRINSIC RISK FACTORS
• Older age • Cognitive impairment • Female gender • Past history of a fall • Leg
weakness or gait problems • Foot disorders • Balance problems • Hypovitaminosis D •
Pain • Parkinson's disease • Stroke • Arthritis
Age-related decline
Changes in visual function Proprioceptive system, vestibular system Regulation of
systolic blood pressure Reduced total body water, risk of dehydration with stressors
Chronic disease
Parkinson's disease Strokes Osteoarthritis, chronic pain
CAUSES: MEDICATION USE
Benzodiazepines Other sedatives Antidepressants Antipsychotic drugs Cardiac
medications Hypoglycemic agents • Recent medication dosage adjustments • Total
number of medications
CLINICAL GUIDELINES
Ask all older adults about falls in past year • Single fall: check for balance or gait
disturbance • Recurrent falls or gait or balance disturbance: Pursue a multifactorial falls
risk assessment
FALL HISTORY
History of falls Activity at time of fall(s) Prodromal symptoms Location and time of fall(s)
Medication history (new, changed, high-risk meds)
• Lighting • Floor coverings • Railings • Furniture • Door thresholds • Footwear
, PHYSICAL EXAMINATION
The most important part includes an assessment of integrated musculoskeletal function
Functional reach test
yardstick test <6in =high risk
Up and Go test (with or without timing)
get up s arm support walk 3m, then sit back down without using arms if >15s =in risk
Berg Balance Test
15 measures incl picking anoject up off the floor
Performance-Oriented Mobility Assessment (POMA)
abnl if 1 pt off for two or more items, or 1.5 off for a single item.
LABORATORY & DIAGNOSTIC TESTING
Tests and procedures should be guided by the history & physical exam:
echocardiography, brain imaging, radiographic studies of spine • Hemoglobin, BUN,
creatinine, glucose: can exclude anemia, dehydration, or hyperglycemia • Holter
monitoring: no proven value for routine evaluation • Carotid sinus massage with
continuous heart rate and BP monitoring is advocated by some for pts with unexplained
falls: can uncover carotid sinus hypersensitivity
FALLS PREVENTION GUIDELINES
Prescribe exercise, particularly balance, strength, and gait training Discontinue or
minimize psychoactive and other medications Manage postural hypotension Manage
foot problems and footwear Supplement vitamin D Treat vision impairment Manage
heart rate and rhythm abnormalities Modify the home environment
TREATMENT
