Falls Flashcards
What should a falls hx include?
- Cirumstances surrounding the fall, including preceding symptoms suggesting medical cause i.e. lightheadedness, vertigo, palpitations
- Look for other potential causes, vision cognition and continence
- Risk factors for osteoporosis
What are the drugs causes of falls?
- Polypharmacy
- Antihypertensives
- Sedatives
- Opioids
- Psychotropics
What are the ageing related causes of falls?
- Presbyopia
- Cognitive decline
- Gait abnormalities
- Reduced postural sway
- Reduced muscle mass
- Slower reflexes
What are the medical causes of falls?
- Cardiac - hypotension, arrhythmias
- Neurological - Parkinson’s, stroke, myopathy
- Osteoarthritis
- Eye problems e.g. cataracts
What are the environmental causes of falls?
- Walking aids
- Footwear
- Home hazards
- Glasses - varifocals
- Fear of falling
What do you want to ask about before the fall?
- Where were they
- What time of day was it
- Is there a pattern to the falls
- Did they have any symptoms before falling
- Why do they think they fell
What do you want to ask about during the fall?
- Did they lose consciousness
- Have they injured themselves
What do you want to ask about after the fall?
- How did they get help
- Were they able to get up
- Have they suffered any complications i.e. long lie, fracture, head injury etc
What would a positive result of BP for postural hypotension?
- Drop in >20mmHg systolic or more (with or without symptoms)
- Drop to below 90mmHg on standing, even if drop is <20mmHg (with or without symptoms)
- Drop in diastolic BP of >10mmHg with symptoms
What are the routine investigations for falls?
- Blood glucose
- ECG
- Gait assessment
- Lying and standing BP
What is vertigo?
Sensation of room spinning around, suggests problem is in vestibulo-labyrithine system.
What are the peripheral causes of vertigo?
- BPPV
- Meniere’s disease
- Vestibular neuritis
- Acoustic neuroma
What are the central causes of vertigo?
- Migraine
- Brainstem ischaemia
- Cerebellar stroke
- MS
What is BPPV?
Patients complain of short spells of vertigo (up to 1 min) that settle spontaneously. It occurs when they move their head (either getting in/out of bed, looking up or turning quickly). It can be diagnosed by the Dix-Hallpike manoeuvre and treated by the Epley maoeuvre.
What is pre-syncopal?
- Feeling as if they are about to faint or complain of feeling lightheaded
- Often when the patient is standing/seated/upright
- Often associated with pallor/relieved by lying
- Suggests cerebral hypoperfusion due to hypotension
- Postural hypotension is a common cause of pre-syncopal symptoms in older patients
What does unsteady mean?
A general feeling of unsteadiness or feeling unbalanced that usually comes from a patients legs rather than their head.
What are the psychogenic causes of falling?
- Fear of falling
- Loss of confidence
- Anxiety/panic attacks/somatisation
- Often associated and exacerbates organic dizziness
What are the causes of transient loss of consciousness?
- Uncomplicated faint or situational syncope
- Orthostatic hypotension
- Dysfunction of the nervous system (epilepsy)
- Dysfunction of CV system (syncope)
- Dysfunction of the psyche (psychogenic attacks)
What are the investigations for TLoC?
- Assess TLoC - details, medications, PMH, FH, general obs
- ECG
- EEG
What do you examine for falls?
- Neurological - upper and lower limb, cognition (AMT, CAM, MMSE)
- Vision/vestibular
- Cardiorespiratory (check peripheral oedema)
- BP
- MSK
What investigations do you do for falls?
- U+E’s (electrolyte abnormalities)
- TFTs/B12/folate - potential causes of peripheral neuropathy
- Vit D level
- ECG - arrhythmias or other abnormalities
- Bone profile - evidence of low or high calcium
- FBC - anaemia and infection markers
- CK - only if long lie for rhabdomyloysis
What would results show for mild dehydration?
- Mild hyponatraemia
- Raised urea
What can increase the risk of falls?
- Medication causing excess fluid loss and sedatives
- Functional deterioration secondary to ageing - postural sway, decreased muscle tone/bulk, impaired sensory input
- Urinary incontinence
What is the management for falls?
- Strength and balance training (exercise is one of the most effective)
- Home hazard assessment and intervention
- Vision assessment and referral
- Medication review with modification/withdrawal
- Manage co-morbidities e.g. diabetes, osteoporosis