Professional Documents
Culture Documents
1. Quick facts
2. Risk Factors
3. Dizziness
4. Meniere's Disease
5. Treatment & Physiotherapy
1. Quick Facts
• Injury due to falls is the leading cause of mortality in older people aged over 75 in the UK.
• Over 85% of all fatal falls are in people over the age of 65. More than half of the over 85’s will fall at least
once a year.
• Every 5 hours someone dies after an accidental fall in the home.
• 86,000 hip fractures occur annually in the UK. 20% of all orthopaedic beds are used by hip fracture
patients.
• It is estimated that the overall direct healthcare cost to the NHS from falls is £15 million every year.
• 95 % of all proximal hip fractures are as a result of a fall; mortality at one year following hip fracture for
age 75 and over is 25-30%.
• Falls can cause distress, pain, injury, loss of confidence and loss of independence.
• After a fall, 48% of older people report a fear of falling and 25% have a functional decline
• Standard six of the NSF for Older People is devoted to the prevention and management of falls & sets out
a plan to develop localised services for falls prevention. Physiotherapists are identified as essential
members of specialised falls prevention teams
2. Risk Factors
Causes of falls in older people are usually multifactorial but include:1
• Accident and environmental hazards (31%)
• Gait and balance disorders or weakness (17%)
• Dizziness and vertigo (13%)
• Drop attack (9%)
• Confusion (5%)
• Postural hypotension (3%)
• Visual disorder (2%)
• Syncope (0.3%)
• Other specified causes incl: arthritis, acute illness, drugs, alcohol, pain, epilepsy & falling from bed (15%)
• Unknown (5%)
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Care Homes Case study Rónán Donohoe, 20 Dec ‘10
3. Dizziness
(Source: www.dizziness-and-balance.com)
Diagnostic Categories
Category Examples
Otological BPPV (about 50% otologic, 20% all)
Meniere’s disease (about 20% otologic)
Vestibular neuritis & related conditions (15%)
Bilateral vestibular loss (about 1%)
Neurological Stroke & TIA,
Migraine
Ataxias
Seizures
MS
Tumours
Head Trauma
CSF pressure abmormalities
Medical Cardiovascular (Orthostatic hypotension, Arrhythmia)
Infection The labyrinth is composed of the semicircular canals,
the otolithic organs (i.e., utricle and saccule), and the
Medication cochlea. Inside their walls (bony labyrinth) are thin,
Hypoglycemia pliable tubes and sacs (membranous labyrinth) filled
Psychological Anxiety with endolymph
Malingering
Undiagnosed Post--traumatic vertigo
Saccule
• a bed of sensory cells situated in the inner ear.
• translates head movements into neural impulses which the brain can interpret
• sensitive to linear translations of the head, specifically movements up and down (think about moving on a
lift)
Any orientation of the head causes a combination of stimulation to the utricles and saccules of the two ears.
The brain interprets head orientation by comparing these inputs to each other and to other input from the eyes
and stretch receptors in the neck, thereby detecting whether only the head is tilted of the entire body is tipping.
The inertia of the otolithic membranes is especially important in detecting linear acceleration
3. Meniere’s disease
• "Meniere" refers to French physician Prosper Meniere, who first
described the symptoms in 1861.
• The cause of this disease is unknown but is thought to be associated
with changes in fluid volume within parts of the labyrinth. Endolymph
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buildup interferes with the normal balance and hearing signals between the inner ear and the brain
causing vertigo & other symptoms
• Meniere's affects roughly 0.2% of the population
• Usually affects only one ear.
Meniere's disease is associated with episodic, fluctuating:
• episodes of vertigo
• irregular hearing loss
• tinnitus (a ringing or buzzing in the ear
• a feeling of fullness in the ear.
Attacks
• Preceded by fullness in one ear
• Hearing fluctuation or changes in tinnitus may also precede an attack.
• generally involves severe vertigo, imbalance, nausea and vomiting.
• The average attack lasts two to four hours.
• Following a severe attack, most people find that they are exhausted and must sleep for several hours.
• There is a large amount of variability in the duration of symptoms.
• High sensitivity to visual stimuli (visual dependence) is common.
• Nystagmus present during the attack
Compensatory mechanisms
• Patients may develop visual dependence – an abnormal sensitivity to complex visual surrounds. May cause
difficulty in driving / shopping. Results from an unsophisticated compensation strategy in which the individual
down-weights vestibular information in favor of visual input.
• Incliniation to stiffen the neck in order to reduce the speed of head-motion. This both reduces vestibular
stimulation as well as makes head orientation more predictable. While this strategy can be effective, can
result in neck pain and discomfort.
Physiotherapy
The main risks to persons with Meniere’s disease is of injury associated with sudden, unpredictable bouts of
dizziness, for which no amount of balance training is likely to prevent. Although Physiotherapy cant address
the underlying disease process there are a number of ways physiotherapy can help
Medications such as meclizine, diazepam, glycopyrrolate, and lorazepam can help relieve dizziness and
shorten the attack.
Salt restriction and diuretics. Limiting dietary salt and taking diuretics may help lower fluid volume and
pressure in the inner ear.
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Other dietary and behavioral changes. Some people claim that caffeine, chocolate, and alcohol make their
symptoms worse. Not smoking also may help lessen the symptoms.
Cognitive therapy. To help cope with unexpected nature of attacks & reduces anxiety about future attacks.
Injections. Injecting the antibiotic gentamicin into the middle ear helps control vertigo but significantly raises
the risk of hearing loss. Alternatively a corticosteroida may be used.
Pressure pulse treatment. The U.S. Food and Drug Administration (FDA) recently approved a device for
Ménière’s disease that fits into the outer ear and delivers intermittent air pressure pulses to the middle ear. The
air pressure pulses appear to act on endolymph fluid to prevent dizziness.
Surgery. If all else fails decompression of the endolymphatic sac or severing the vestibular nerve, although
this occurs less frequently.
Alternative medicine. Little evidence to show the effectiveness of acupuncture or acupressure or tai chi.
References / Links
1. Rao SS; Prevention of falls in older patients. Am Fam Physician. 2005 Jul 1;72(1):81-8. [abstract]
2. Malmivaara A, Heliovaara M, Knekt P, Reunanen A, and Aromas A. (1993) Risk Factors for Injurious Falls
Leading to Hospitalization or Death in a Cohort of 19,500 Adults. American Journal of Epidemiology
138:384-394.
http://www.nidcd.nih.gov/health/balance/balance_disorders.html
www.dizziness-and-balance.com
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