Elderly - Immobility and Falls Flashcards
How do drugs cause falls?
Decreasing BP, HR and awareness
Increasing Urine output, sedation, hallucinations, QT length, dizziness
Which drugs are cause a high risk of falls?
Antihypertensives Beta blocker Sedatives Anticholingerics Opioids Alcohol
Who works in a falls clinic?
Full MDT - treatment plan
Nurse - examinations
Physiotherapist - gait/balance
Doctor - Hx and bone health
What else must be asked in a falls enquiry?
Memory - ask a relative
Urinary symptoms
Recent changes in gait
Drugs
High stepping is suggestive of what?
Peripheral neuropathy
Small, shuffling steps are suggestive of what?
Parkinsonism
Hemiplegia is suggestive of what?
Stroke
Ataxia is suggestive of what?
Cerebellar damage
What examinations/investigations should be used in a falls assessment?
Neuro exam Chest/heart/abdo Look at legs and gait History Obs ECG for all Bloods Delirium - 4AT Consider head CT if head injury/neuro signs
When is CT head indicated in falls?
GCS <13 Confused after 2hrs Focal neurology Signs of skull fracture CSF leak/panda eyes Seizure Vomiting Anti-coagulation
What causes falls in inpatients?
Patient getting postural hypertension due to illness New medication Low blood glucose Getting more ill Delirium Deconditioning
What should nurses do post-fall?
Repeat risk assessment
Datix
Call family
Prevent further fall
