Falls

Question 1

types of injuries sustained from falls

Answer 1

fractures
soft tissue injuries - heamatomas, lacerations
head injuries - subdural haematomas, cerebral contusions
consequences of a long lie if cannot get up or get help

Question 2

common types of fractures in elderly from falls

Answer 2

Hip
radius
vertebral crush fracture
pelvis
neck of humerus
rib

Question 3

common consequences of a long lie

Answer 3

hypothermia
rhabdomyolysis - high CK, renal failure, myoglobinuria
dehydration
pressure sores

Question 4

post fall syndrome

Answer 4

also ‘fear of falling syndrome’

Question 5

age related changes that may lead to falls

Answer 5

neuromuscular: balance impairment, wider base, reduced lower limb strength, increased postural sway, delayed reaction time, decreased righting reflexes
vision: decreased visual acuity, accommodation, peripheral vision, depth perception, glare tolerance

Question 6

intrinsic risk factors for falls

Answer 6

Hx of falls
fear of falling
female
living alone
polypharrmacy
chromic disease
impaired cognition
visual impairments
foot problems

Question 7

syncope

Answer 7

transient loss of anxiousness secondary to inadequate cerebral perfusion with oxygenated blood

Question 8

causes of syncope

Answer 8

underlying cause may be reflex mediated (eg. vasovagal), cardiac (eg. structural heart disease, arrhythmia), orthostatic (Parkinson’s, volume depletion, drugs), cerebrovascular (seizure, migraine)

Question 9

important points on physical examination for falls

Answer 9

postural blood pressure
cardiovascular exam
neurological exam
gait
balance
assessment of feet and footwear

Question 10

postural hypotension is defined as

Answer 10

sustained fall in systolic BP of at least 20mmHg or diastolic BP of at least 10mmHg within 3 minutes of standing
patients who have drop in BP immediately on standing than normalises within 3 minutes can be education about rising slowly and waiting before starting to walk

Question 11

TUGT

Answer 11

timed up and go test
rising from seated position, walking three metres and then walking back
time >12 seconds considered increased risk of falls

Question 12

exercise to prevent falls

Answer 12

most effective are those that improve leg strength and challenge balance
walking alone not shown to prevent falls

Question 13

medications associated with falls

Answer 13

anticonvulsants
antidepressants
antihypertensives
antiparkinsonian drugs
antipsychotics
benzodiazepines
digoxin
diuretics
laxatives
opioids
NSAIDs

Question 14

medication used for postural hypotension

Answer 14

fludrocortisone

Question 15

optimising vision

Answer 15

eye tests - 2 yearly on medicare
change multifocal to single lens
referral for cataract surgery

Question 16

vit D supplimentation

Answer 16

for patients with osteoporosis

Question 17

fracture risk

Answer 17

previous vertebral or hip fracture after minimal trauma should be offered pharmacological treatment for osteoporosis
women aged 65 years of age or older without a previous vertebral or hip fracture should undergo testing for bone mineral density