Falls

Question 1

Falls management (8)

Answer 1

• Review meds: Anti-HTN, optimise anti-PD, wean SSRI
• Optimise electrolytes, Hb, vitamin D
• Appropriate footwear, prosthesis, walking aids
• Gait, exercise and balance training
• Rehab/PT
• ? Glasses needed
• Ax house - loose rugs, ramps, bars, rails, personal alarm
• ECG/holter monitor

Question 2

Mobility (5)

Answer 2

• Stroke/cerebellar
• Muscle weakness
• Arthritis
• Spinal disease
• Inappropriate footwear

Question 3

O/E (6)

Answer 3

• Timed U&G - <10 seconds
• Rhombergs/*Proprioception
• Postural BP
• VA
• Muscle strength
• ECG

Question 4

Management (13)

Answer 4

• Falls and balance OPC
• Gait and balance training - exercise/group classes
• PT: gait aids
• OT home Ax: decrease clutter, lighting, rails
• Medication review
• Vision/hearing assessment
• Appropriate footwear/prostheses
• Vitamin D
• Toileting
• Psychology - fear of falls
• Education - behaviour/mood
• Hip protectors
• Footwear

Question 5

*Decrease risk of serious injury (3)

Answer 5

• Personal alarm
• R/v need for AC - *rarely C.I.
• Bone health - vit D, Ca, DEXA +/- BP

Question 6

Falls (3)

Answer 6

1) Cause of fall - syncope, presyncope, vertiginous
2) Stop fall - pattern, freq, over 6-12/12
3) Decrease Cx/injury

Question 7

Intrinsic factors (10)

Answer 7

• Deconditioning (sarcopenia, muscle wasting)
• Vision impairment
• Pain w immobility - eg secondary to OA
• Neuro
• Meds
• Postural hypotension
• Cognitive impairment
• Feet
• ETOH
• BSLs

Question 8

Extrinsic factors (4) - MONEY

Answer 8

• Uneven surfaces - proprioceptive loss
• Poor lighting
• Clutter/hoarding
• Distance to bathroom

Question 9

How to stop fall? (5)

Answer 9

IF:
- optimise meds, pain
- r/v drugs
- Cataracts
- Postural BP
- PT: strength and balance program

EX factors:
- OT - home Ax
- PT - gait aid

Question 10

AH falls program (3)

Answer 10

• PT - balance
• Home Ax
• PT - gait aid

Question 11

Stop Cx (4)

Answer 11

1. Broken bones (OP)
2. Long lie - rhabdo, pressure sore, hypothermia - personal alarm, mobile phone, personal care assistance, falls edu: how to get up after a fall
3. Fear of falling - PT graduated exercise program, health psychology
4. Bleed - continue AC and discuss risk with patient

Question 12

High risk faller (2)

Answer 12

• LOC/cardiogenic
• PD with retropulsion