Falls

Question 1

What is a Fall?

Answer 1

An event which causes a person to unintentionally rest on the ground or other lower level.

Question 2

What does normal gait involve physiologically? (3)

Answer 2

1. Neurological System - Basal Ganglia and Cortical Basal Ganglia Loop.
2. Musculoskeletal System.
3. Effective Processing of Senses.

Question 3

Risk Factors of Falls (10).

Answer 3

1. Previous History of Falls.
2. Lower Limb Muscle Weakness.
3. Vision Problems.
4. Balance/Gait Disturbances e.g. Parkinson’s, RA, Diabetes.
5. Polypharmacy (4+), Psychoactive Drugs, Cognitive Impairment.
6. Incontinence.
7. Ageing.
8. Fear.
9. Depression.
10. Postural Hypotension.

Question 4

What medications are associated with Postural Hypotension?

Answer 4

1. Nitrates.
2. Diuretics.
3. Anticholinergic Medications.
4. Antidepressants.
5. B-Blockers.
6. L-Dopa.
7. ACE Inhibitors.

Question 5

What medications are associated with falls due to other mechanisms? (7)

Answer 5

1. Benzodiazepines.
2. Antipsychotics.
3. Opiates.
4. Anticonvulsants.
5. Codeine.
6. Digoxin.
7. Other Sedative Agents.

Question 6

What is Postural Hypotension?

Answer 6

Fall of 20mmHg SBP or Fall of 10mmHg DBP.

Question 7

Clinical Presentation of Postural Hypotension (6).

Answer 7

1. Dizziness.
2. Syncope.
3. Falls.
4. Fractures.
5. Following Meals, Exercise, Warm Environment.
6. Trigger : Cough, Defecating, Standing Up.

Question 8

Aetiology of Postural Hypotension (6).

Answer 8

1. Drugs.
2. Chronic Hypertension (Loss of Baroreceptor Reflex).
3. Dehydration.
4. Sepsis.
5. Autonomic Nervous Dysfunction e.g. Parkinson’s, Diabetes.
6. Adrenal Insufficiency.

Question 9

Management of Postural Hypotension.

Answer 9

1. Treat Underlying Cause.
2. Ensure adequate hydration.
3. Evaluate poly pharmacy.

Question 10

Investigations of Falls (4).

Answer 10

1. A-E Assessment.
2. Bedside Tests : Observations, Blood Glucose, Urinalysis, ECG, BP.
3. Bloods : Routine Bloods and Bone Profile.
4. Imaging : X-Ray, CT Head and Cardiac Echo.

Question 11

Risk Management of Falls (2).

Answer 11

1. Identify anyone who has fallen in the last 12 months.
2. Identify their risk factors.
3. Complete ‘Turn 180’ Test or ‘Timed Up and Go Test’.

Question 12

MDT Management of Falls.

Answer 12

Anyone 65+ and :

1. > 2 Falls in Last 12 Months.
2. Fall Requiring Medical Treatment.
3. Poor Performance or Failure to Complete Tests.

Question 13

Clinical Consequences of a Fall.

Answer 13

1. Injury - Fracture, Soft-Tissue, Head.
2. Pressure Sore.
3. Hypothermia.

Question 14

Psychological Consequences of a Fall (2).

Answer 14

1. Loss of Confidence.

2. Institutionalisation.