Elderly/Frail Non-Injury Fall

Question 1

What are the 3 categories of fall causes?

What is their preventability rating?

Answer 1

1. Mechanical (preventable) - poor lighting, uneven ground, footwear
2. Known medical (may be preventable) - postural hypotension, poor gait, medication change, confused pt
3. Unanticipated event (not preventable) - seizure, AMI

Question 2

What are the 8 key factors when assessing falls risk?

Answer 2

1. Sensory impairment
2. Medication (recent changes, CV meds, multiple meds)
3. Mobility issues, use of mobility aids
4. Altered cognitive state
5. Continence issues
6. Environment is unsafe (stairs, rugs, wires, footwear)
7. Hx of falls
8. Depression

Question 3

Define falls.

Answer 3

A fall is any event where a person comes to rest inadvertently on the ground, floor or other lower level.

Question 4

At what age is a pt considered elderly? What other factors may cause someone under this age to be considered as a falls risk?

Answer 4

> 65.

Consider frailty status, comorbidities or baseline level of functioning.

Question 5

Any fall that occurs while a pt is in AV care must…?

Answer 5

be reported via Riskman.

Question 6

What needs to be done for pts who are at a risk of falls but are not being transported to hospital? When should a non-injured pt be transported rather than referred to their LMO?

Answer 6

Paramedics contact GP and refer pt.

If socially or geographically isolated.

Question 7

What assessment should be made in addition to looking for injuries in falls pt’s who may have spent some time on the ground?

Answer 7

Pressure sores and dehydration.

Question 8

In regards to falls patients, there is a very low threshold for transporting…?

Answer 8

Pts on anticoagulants. If there is a headstrike, the pt must be transported.

Question 9

What are the 4 assessment points under the non-injured falls guideline?

Answer 9

1. Does the pt have full recollection of event?
2. Is the fall due to environmental/mechanical issue that can be resolved?
3. Was the pt able to get up with out assistance or call for help relatively quickly?
4. Consider key risk factors for risk of subsequent falls.

Question 10

If low risk for non-injured falls criteria, what is the management?

Answer 10

Contact GP for appt.
OR
With consent, contact support person for pt and outline risk of subsequent falls - encourage GP follow up.

Question 11

If not low risk, and pt requires medical follow-up for a non-injured fall, what is the management?

Answer 11

Strongly recommend transport to ED, or via NEPT.
If pt refuses transport:
Contact GP for appt. to discuss risk assessment
AND
With consent, contact support person for pt, outline risk of subsequent falls.