2.2 Managing Falls Flashcards
How common are falls in the elderly?
30% of over 65s, 50% of over 80s fall at least once a year, some several times a week
How might falls impact a patients life?
Reduced quality of life
Loss of confidence
Loss of independence
Mortality
Why is the history of the fall the most important tool?
Helps establish or narrow the cause of the fall. There is a massive differential diagnosis of falls and we need to narrow down the potential causes.
What 5 factors must be considered when taking a history for a fall
Who? When? Where? What? - before, during, after How?
What are we considering when we are thinking about who?
H
What are we considering when thinking about where?
G
What are we considering when thinking about what?
What happened before during and after the fall
- continue
What are we considering when thinking about how?
Thinking about time. How long where they on the floor for? How many times has the patient fallen over before? How many in the last 6 months? Any serious injuries?
What is a major risk factor when a patient is lying on the floor for a long time after a fall?
HH
What is pre-syncope?
Symptoms preceding a syncopal episode, including • Light-headedness • Sweating • Pallor • Blurred vision
What is orthostatic hypotension?
A
What is the function of the baroreceptors?
H
Why does the baroreceptor reflex fail with age?
Less circulating volume - dehydration common in elderly
Large and medium blood vessels less compliant - increases TPR and causes hypertension
Baroreceptors become less sensitive with age and hypertension
Medications such as anti-hypertensives can impair baroreceptors response to low BP
Why is it important to take a drug history when assessing a fall in the elderly?
Polypharmacy - on many different medications
New medications - side effects
Anti-hypertensives/ anti-arrhythmials
Drugs inducing drowsiness - new analgesia/benzodiazepines/antidepressants/antipsychotics
Have they had a recent medication review?
