2 - Managing Falls Flashcards

1
Q

What are some of the common causes of falls in older people?

A

Syncopal or Non-Syncopal (INTRINSIC OR EXTRINSIC)

  • Trips on hazards
  • Diabetes
  • OA
  • Stroke
  • UTI
  • Aortic stenosis
  • Vasovagal episode
  • Ruptured AAA
  • Post micturition syncope
  • Postural hypertension
  • Hip OA
  • Dehydration
  • GBS
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2
Q

What questions do you need to ask in a history of a present complaint if someone presents with a fall?

A

Who? - Did anyone see so can take collateral history

When? - Night/Vision, did they get up out of a chair or go to the toilet

Where? - Home, shops, any trip hazards or flashing lights from TV

What? - Before, During, After

How? - How long on the floor for rhabdomyolysis, how many times before and in last 6 months, any serious injuries

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3
Q

What questions do you need to answer in the WHAT section of taking a history for a fall?

A

COLLATERAL HISTORY IMPORTANT

Before:

  • Any symptoms before like lightheadedness?
  • Chest pain?
  • Trip?

During:

  • Loss of consciousness?
  • Incontinence, tongue biting, shaking, pale?
  • Any injuries

After:

  • Did they regain consciousness quickly?
  • Could they get up without help?
  • Any confusion or neurological symptoms?
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4
Q

What are the most common causes for loss of consciousness?

A

Syncope

Seizures

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5
Q

What is syncope and what are the symptoms of pre-syncope?

A

Transient loss of consciousness characterised by fast onset and spontaneous recovery due to reduced perfusion pressure in the brain. It is self limiting

  • Light headedness
  • Sweating
  • Pallor
  • Blurred vision
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6
Q

Why is it important to think about a seizure in an elderly patient if they have had loss of consciousness during a fall?

A
  • Lots of new epilepsy diagnoses present at older age
  • Seizures can be really subtle, e.g a twitch, so ask collateral if any abnormal movements
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7
Q

What are the three main categories of the causes of syncope?

A
  • Reflex syncope
  • Orthostatic hypertension
  • Cardiac/Cardiopulmonary Disease
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8
Q

What is reflex syncope and some examples of this?

A

Brief loss of consciousness due to a neurologically induced drop in blood pressure as there is a drop in sympathetic innervation so heart rate goes down and so does cardiac output and blood pressure

- Vasovagal: prolonged standing, stress etc

- Situational: coughing, straining

- Carotid Sinus massage: tight collar

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9
Q

What is the definition of orthostatic hypotension?

A

Decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within three minutes of standing when compared with blood pressure from the sitting or supine position

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10
Q

What is the pathophysiology behind orthostatic hypotension (postural) syncope? (baroreceptor reflex important)

A
  • Standing up causes 500/800ml of blood to pool in legs
  • Decrease in EDV and therefore CO and therefore BP
  • Baroreceptors detect this and raise CO by increasing HR and contractility
  • If baroreceptor reflex fails there is not an increase in CO so syncope as loss of perfusion pressure
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11
Q

What are some causes of baroreceptor reflex failure?

A

- Lose sensivity with age and hypertension

- Dehydration (so elderly need to drink regularly)

- Medications like antihypertensives

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12
Q

What are some causes of cardiac syncope?

A

DO ECG ON ANYONE PRESENTING WITH FALL

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13
Q

Why does aortic stenosis lead to syncope and why does it need to be detected and treated quickly?

A
  • Narrowing of the aortic valve so heart has to work harder so if exercising can fail to adequately perfuse brain
  • Mean survival is 2-5 years if untreated
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14
Q

What are some red flags in a patient’s history that would indicate their syncope is cardiac related?

A
  • Exertional syncope
  • Family history of cardiac disease or sudden cardiac death
  • Preceding chest pain or palpatations
  • PMH of heart disease, e.g ASD as a kid
  • Abnormal ECG
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15
Q

What is the most common cause of a non-syncopal fall?

A

- Trips and slips

  • Can be multifactoral e.g OA and diabetic nephropathy and tripping on hazard
  • LOC following head trauma is still non-syncopal fall
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16
Q

Apart from the presenting complaint, what are some other important aspects to take a history of when a patient presents after a fall?

A

Drug History:

polypharmacy?

any new medications?

any drugs that can induce drowziness? (antidepressants, benzodiazepenes, analgesia)

antihypertensies?

have they had a medication review in the past year?

Social History:

  • alcohol and smoking?
  • who do they live with and do they have help?
  • do they have walking aid or furniture walking?
  • any stairs?
  • family close by?
17
Q

What type of walking aid is not recommended?

A

Refer to OT if using walking wheeler as these can cause issues with stability and falls

18
Q

What examinations should you perform on a patient presenting after a fall?

A
  • Palpate all bony prominences to check for fractures
  • Full neurovascular, cranial nerve, respiratory and CVS exam
19
Q

What investigations should you perform when a patient presents after a fall?

A
20
Q

Why should we be concerned about rhabdomyolysis in a patient following a fall?

A
  • Can cause electrolyte disturbances, DIC, renal failure, organ failure
  • Can be from trauma, prolonged immobilisation, after marathons
  • Serum CK will be 5 times upper limit of normal
21
Q

What are some classes of drugs that can lead to falls in the elderly?

A
  • Antihypertensives
  • Anti-arrhythmics
  • Analgesia
  • Benzodiazepenes
  • Antidepressants
  • Antipsychotics

Patients taking 4 or more drugs at more risk of falls

22
Q

What are some practical solutions to minimise the risk of falls in the elderly?

A
  • Vision test
  • Drink plenty
  • Does patient need increased help at home?
  • Remove trip hazards like rugs and bad lighting
  • Have regular medication reviews
  • OT assessment of home and walking aids
  • Stand up slowly
23
Q

What are some terms that should not be used on a patients notes when treating the elderly?

A
  • Acopia (inability to cope with daily activites of living)
  • Social Admission (no acute medical needs)
  • Mechanical fall
  • Failed discharge
  • Bed blocker
24
Q

What factors are involved in maintaining our balance?

A