Case 6: Falls Flashcards
What are the non- modifiable risk factors for falls?
- Age
- Gender
- History of falls
What are the neurological risk factors for falls?
- Cognitive impairment or Dementia
- Confusion/delirium
- Depression
- Poor vision
- Poor balance (arthritis, parkinson’s)
- Poor co-ordination
- Anxiety about falling
What are the environmental risk factors for falls?
- Home hazards
- Inappropriate footwear
- Insufficient home modification
What are the chemical risk factors for falls?
- Polypharmacy
- Drug culprits (e.g. corticosteroids)
- Alcohol
What are the cardiovascular risk factors for falls?
- Orthostatic hypotension (low blood pressure upon standing up)
- Arrhythmias
- Syncope (temporary drop in blood to the brain that causes fainting)
- Anaemia
What is collateral history?
Taking history of a patient from an onlooker or relatives.
How can you prevent falls?
- Clean up/declutter the environment
- Better feedback
- Do regular strength and balance activities (physiotherapy)
- Eyesight checks (optician’s)
- Reduce alcohol intake
- Correct low BP
What is delirium?
A worsening or change in person’s mental state that happens suddenly, over 1-2 days.
What are the 3 different types of delirium?
- Hyperactive
- Hypoactive
- Mixed
What are the symptoms of hyperactive delirium?
- Restlessness
- Agitation
- Delusions
- Hallucinations
- Disorientation
- Paranoia
What are the symptoms of hypoactive delirium?
- Withdrawn mood
- Drowsiness
- Unable to focus
- Less mobile
- Somnolent
What are the risk factors of delirium?
- Age
- Underlying cognitive impairment
- Social isolation
- Pain from fall
- Renal impairment
- Poor mobility (previous falls)
- Visual/hearing problems
- Alcohol
What are the triggers of delirium?
- Pain
- Infection
- Nutrition (deficiencies like Vit B12, folate, thiamine, Vit D)
- Constipation
- Hydration
- Medication (drug culprits)
- Electrolytes
What is the treatment of delirium?
1) Address the medical problem that caused it (correct glucose levels, stop medication that may be causing it, give antibiotics).
2) Ensure a supportive + calm environment for patient
What tests are carried out for a patient that’s had a fall and is delirious?
- ECG
- Blood tests
- Chest X-ray
- Urine sample (to test for UTIs)
- Hip X-ray
What are fragility fractures?
Fractures that result from mechanical forces that would not ordinarily result in a fracture (equivalent to falling from standing height).