falls

Question 1

who falls?

Answer 1

increased incidence with age
50% of >80 fall once a year
3x higher in care home relatives

Question 2

medical conditions which contribute to falls

Answer 2

o Diabetes mellitus – diabetic neuropathy – altered proprioception + poor vision
o Arthritis, parkinson’s, stroke – altered gait pattern
o Incontinence – increased need to rush, mobilising at night
o Acute illness (almost anything)

Question 3

things about the patients which contribute to falls

Answer 3

medical conditions
cognition
impaired vision and hearing - check for vision distortion (age-related macular degeneration)
age related changes in gait, postural reflexes, muscle strength etc.
medications

Question 4

what medications can increase falls risk?

Answer 4

diuretics, anti-hypertensives, sedatives, anti-cholingergics, hypoglycaemic agents.

Question 5

environmental factors which can increase falls risk?

Answer 5

rugs, furniture etc.
Inadequate lighting – falls at night
Inappropriate footwear
Inappropriate use of walking aids

Question 6

why does a fear of falling increase the risk of further falls

Answer 6

cautious gait – short shuffling steps not lifting feet

Question 7

how can falls risk be reduced?

Answer 7

psychotropic drugs - stop to reduce falls risk
systolic BP 110mmHg or below associated with increased fall risk so BP control shouldn’t be excessive
manage peripheral neuropathy
manage orthostatic hypotension
minimise neuro and cv conditions

Question 8

how to assess falls

Answer 8

thorough history from patient 
collateral history 
exam - injury, cardio, neuro and vision
further tests 
investigations 
o	ECG
o	Blood sugar 
o	Postural BPs 
o	Echo
o	CT head if new neurological deficit

Question 9

how are falls managed?

Answer 9

• strength and balance training (3 times a week for at least 12weeks)
• home hazard assessment and intervention
• vision assessment and referral
• medication review with modification/withdrawal