3+ Falls Flashcards
What is the epidemiology of falls?
1/3 of community dwelling adults >65 fall at least once a year
Serious injuries occur in 1/10 falls
What is the aetiology of falls?
- Syncope: transient loss of consciousness secondary to inadequate cerebral perfusion with oxygenated blood
- Reflex mediated: vasovagal
- Cardiac: arrhythmia, structural heart disease
- Orthostatic: primary = parkinson’s, secondary= volume depletion, drugs
- Cerebrovascular: seizure, migraine - Non-Syncope:
- Intrinsic
- Extrinsic
What are some non-modifiable risk factors?
Age related changes:
- Neuromuscular: balance impairment, wider base, reduced LL strength, increased postural sway, delayed reaction time
- Vision: decreased visual acuity, accommodation, peripheral vision, depth perception
- Vestibular: decreased vestibular excitability
- Cognitive impairment/dementia
- Hx of TIA/stroke
- Hx of falls
- Female
What are some potentially modifiable risk factors?
- Medication
- Psychological: depression, fear of falling
- Comorbidities that impact motor and sensory function (Parkinson’s, vertigo, DM, arrhythmias, HTN, CCF, gait balance, foot problems, muscle weakness, postural hypotension, OSA)
What are some extrinsic vs intrinsic risk factors for fall?
Extrinsic:
- environmental hazards, inadequate footwear, incorrect walking aids
Intrinsic:
- History of falls, fear of falling, female sex, living alone, polypharmacy, chronic disease, impaired cognition, visual impairments, foot problems
What are the general principles of falls management?
- Medication review: prescribed and OTC
- Careful for medications that cause sedation, confusion, postural hypotension - Postural hypotension Mx
- Mx of Functional status:
- ADLs
- Home visit if needed - Vision
- Change multifocal to single lens
- Referral for cataract surgery - Foot care
- Advice about footwear
- Podiatry intervention - Cognition and mood
- MOCA
- Evaluate for reversible causes e.g. hypothyroid - Manage urinary incontinence
- Bladder diary - Treat any fractures if they occur and manage osteoporosis
How can you prevent injuries from falls?
- Treat any osteoporosis if it exists
- Vit D
- Calcium
- Denosumab
- Bisphosphonates
- If they’ve never had a DEXA and are over 65 they should have one
What are some complications of falls?
- Fractures
- Soft tissue injuries: haematomas, laceration
- Head injuries: subdural haematoma, cerebral contusions
- Consequences of a long lie = hypothermia, rhabdomyolysis (high CK, renal failure, myoglobinuria), dehydration
- Fear of falling syndrome
What are the most common fractures to occur from falls?
Hip = NOF
Colle’s (radius)
Vertebral crush fracture
Pelvis
Neck of humerus
Rib
What is fear of falling syndrome?
Fall
Fear of a further fall
Avoidance Behaviour
Inactivity
Physical de-conditioning
Muscle weakness + gait instability
Greater risk of further falls
What is a good structure for falls history?
Who
When
Where
What: before, during, after
Why
How: how many falls have you had
Injuries as a result
What are some ‘before’ symptoms to ask for in a falls history?
- Warning symptoms
- Dizziness
- Chest pain
What are some important ‘during’ symptoms to ask in a falls history?
- Incontinence, tongue biting, convulsions (seizure)
- Any loss of consciousness?
- Really hot or cold (vasovagal)
- Did you injure yourself
- Did you hit your head
- What part of your body hit the floor first?
What are some important ‘after’ symptoms to ask about in a falls history?
Were you able to get yourself up?
Did you feel confused after? (head injury)
Did you have any weakness or speech difficulty? (stroke/TIA)
What are the parts of an examination when someone has had a fall?
AMT4
CVS
MSK: LL for deformity and ROM
Neuro: cognition + LL
Vision: visual acuity, peripheral vision
Gait and balance
TUGT
