Falls

Question 1

If you fear falling what is more likely to happen?

Answer 1

Increased risk of falls as reduce movement - which makes more nervous - vicious cycle

Question 2

What assessment tool should always be done on a falls patient?

Answer 2

4AT and MOCA

Cognitive problems massively increase your falls risk

Question 3

What question should you ask surrounding eyesight?

Answer 3

If any distortion?

Early eye surgery can help reduce falls risk

Question 4

Do psychotropic drugs like antidepressants and antipsychotics increase or decrease risk of falling?

Answer 4

increases - remember to screen and review use

Question 5

What class of anti-HTN can cause severe orstostaic hypotension and as a result falls?

What condition is this drug also used for?

What HTN drug is important to be kept on as has a survival benefit in systolic cardiac failure?

Answer 5

Alpha blockers e.g. -osin

Prostatism

ACEi and Beta-blockers

Question 6

Romberg’s test is recommended to be done in patients with gait disturbance. What is Romberg’s test

Answer 6

When you get patient with shoes off to stand still and you count how long they can last with their eyes shut.

Good for proprioceptive and vestibular disorders

Question 7

How do you manage peripheral neuropathy as a cause of falls?

Answer 7

Treat any reversible cause

• alcohol
• diabetes
• vit B12 deficent
• hypothyroidism

Correct use of walking aids
Proper shoes and orthotics
Balance and strength exercises

Question 8

OH is most common cause of syncope. What are the other causes?

Answer 8

Arrthmyias
carotid sinus hypersensitivity
Seizures

Question 9

What conditions can present with neurogenic OH?

Answer 9

Parkinson’s and Lewy body dementia

Question 10

What lifestyle advice can be given to those with OH?

Answer 10

‘water loading’ - big glass of water before getting up
avoid sudden changes
stop any culprit drugs
~increase salt in diet

Question 11

Imagine someone has come in with a fall what do you want to know in the history?

Answer 11

Where did it occur?
Where they able to get up/push community alarm?
How long were they lying for?
What happened before/during/after?
Any LOC? If so how long?
When did it happen?
Any injuries?
Did you hit your head?
When was the last time you fell?
Do you have a fear of falling?

Question 12

What examinations should be done in a falls patient?

Answer 12

• General Obs
• Check for injury
• Cardio
• Neuro
• Vision
• 4AT +/- MOCA

Question 13

What invx should be done for falls?

Answer 13

Blood sugar
Postural BP
ECG
Timed up and go - check movement and how they get up and down 
Echo if indicated

Question 14

What anti-HTN causes peripheral oedema again?

Answer 14

CCB

Question 15

How is OH defined?

Answer 15

Drop of 20 systolic and 10 diastolic

Question 16

What is done to manage falls?

Answer 16

Strength and balance training (3x week for 12 weeks)
Home hazard assessment and intervention by OT
Vision assessment and referral
Medication review with modification/withdrawl

Question 17

What condition can cause drop attacks?

Answer 17

Carotid sinus syndrome - abnormal activation of baroreceptors in this area - causes decrease in BP

Risk increases as you get older