Falls

Question 1

What systems are involved in normal gait?

Answer 1

Neuro - basal ganglia and cortical basal ganglia loop

MSK - tone and strength

Processing of senses - sight, sound and sensation (fine touch and proprioception)

Question 2

What are the risk factors for falls?

Answer 2

Lower limb muscle weakness

Vision problems

Balance/gait disturbances (diabetes, rheumatoid arthritis and parkinson’s disease etc)

Polypharmacy (4+ medications)

Incontinence

>65

Postural hypotension

Arthritis in lower limbs

Cognitive impairment

Question 3

What to ask in a falls history?

Answer 3

Where was the patient when they fell?

When did they fall?

Did anyone else see the patient fall? (collateral history)

What happened before/during/after?

Why do they think they fell?

Have they fallen before?

Systems review

Past medical history (especially issues related to balance/sight/gait)

Social history

Question 4

Which medications cause postural hypotension?

Answer 4

Nitrates

Diuretics

Anticholinergics

Antidepressants

BBs

Levodopa

ACEi

Question 5

What meds can cause falls due to other mechanisms?

Answer 5

Benzodiazepines

Antipsychotics

Opiates

Anti-convulsants

Codeine

Digoxin

Other sedatives

Question 6

What investigations to complete for falls?

Answer 6

Bedside = basic obs, BP, BM, dipstick, ECG

Bloods = FBC, U&Es, LFTs, bone profile

Imaging = CXR, XR for fractures, CT head, cardiac echo

Question 7

How is lying standing BP recorded?

Answer 7

After 5 mins of lying down and then within 5 minutes of standing

(Postural hypotension = drop of more than 20mmHg)