Falls

Question 1

Define a “fall” and a “loss of balance”

Answer 1

Loss of balance:
* Unsteadiness when sitting, standing, or walking that may result in a fall.

Fall:
* “an event that results in the individual coming to rest inadvertently on the ground or floor or other lower
surface”

Question 2

Describe the epidemiology of falls in Australia and their significance

Answer 2

Falls related deaths are the 6th most common cause of death amongst elderly population
* 75% of people who die from a fall are over the age of 65
* 20% of falls for elderly result in hip fractures
* Falls account for 90% of fractures in elderly
* Projecting cost for healthcare system

Question 3

Explain the cyclical nature of the fear of falling.

Answer 3

Fall -> loss of confidence -> less physical activity/social -> balance and walking deteriorate -> risk of fall increase.

• Decreases independence, Carer burden, change care level

Question 4

What are some common differential diagnosis associated with traumatic causes of a loss of balance, dizziness or falls that need to ruled out?

Answer 4

BPPV
Traumatic brain injury

Question 5

What is a common differential diagnosis associated with metabolic causes of a loss of balance, dizziness or falls that need to ruled out?

Answer 5

Diabetic neuropathy

Question 6

What are some common differential diagnosis associated with vascular causes of a loss of balance, dizziness or falls that need to ruled out?

Answer 6

• CVA
• orthostatic/postural hypotension

Question 7

What are some rare differential diagnosis associated with vascular causes of a loss of balance, dizziness or falls that need to ruled out?

Answer 7

• vasculitis
• Walenberg’s syndrome
• VBAI

Question 8

What is a common differential diagnosis associated with congenital causes of a loss of balance, dizziness or falls that need to ruled out?

Answer 8

Hydrocephalus

Question 9

What is a common differential diagnosis associated with neurogenic/pyschologenic causes of a loss of balance, dizziness or falls that need to ruled out?

Answer 9

Peripheral neuropathy

Question 10

What is an uncommon differential diagnosis associated with neurogenic/pyschologienic causes of a loss of balance, dizziness or falls that need to ruled out?

Answer 10

meniere’s disease

Question 11

List the most common intrinsic risk factors that are associated with falls.

Answer 11

1. Previous falls
2. Balance
3. Mobility

Question 12

Examples of poor footwear which increases the risk for an elderly persons to fall

Answer 12

Poor fitting
lack of fixation
high heels
slippers
socks

Question 13

Good footwear includes

Answer 13

• thin soles (foot position)
• low square heel (balance)
• supportive collar (balance)

Question 14

what tests would you perform for vertigo, or other balance disorders?

Answer 14

Berg balance scale & TUG test

Question 15

If you decide your patient does not need a referrel and hasn’t sustrained a fracture, what questions would you ask?

Answer 15

“SPLAT”
- Symptoms associated
- Prior falls
- Location of the fall
- Activity at the time
- Time of day
- Trauma (physical, psychological)

Question 16

What medication is important to consider for osteoporosis?

Answer 16

HRT- hormone replacement therapy

Question 17

Lifestyle changes for osteoporosis

Answer 17

Nutrition
Calcium + vit D
No smoking , alcohol
Weight bearing exercises

Question 18

What is the Mc cause of dizziness and vertigo?

Answer 18

BPPV (Benign paroxysmal positional vertigo)

Question 19

In older pople with cognitive impairment, what has been found to be associated with increase risk falls?

Answer 19

• Confusion
• Disorientation
• Dementia

Question 20

Confusion, disorientation, and dementia have all
been found to be associated with falls. What are some other risk factors for falls which are more prevalent in older people with cognitive impairment

Answer 20

• Gait and balance
• Psycoactive drugs prescribed
• Orthostatic hypotension

Question 21

How to manage the health status of olderly patients to minimize the risk of falls

Answer 21

• Physical activity
• Environmental hazards
• Hydration and nutrition
• Osteoporosis Ax/Mx
• Medications (where possible)

Question 22

Differential diagnosis: Common Traumatic causes for loss of balance and falls

Answer 22

BBPV
Traumatic brain injury

Question 23

Uncommon Inflammatory cause for loss of balance and falls

Answer 23

Aseptic: : Multiple sclerosis (MS)

Question 24

Differential diagnosis: Common congenital causes for loss of balance and falls

Answer 24

Hydrocephalus

Question 25

Differential diagnosis: Common neurogenic/pyschogenic causes for loss of balance and falls

Answer 25

Peripheral Neuropathy

Question 26

Differential diagnosis: uncommon neurogenic/pyschogenic cause for loss of balance and falls

Answer 26

Meniere’s disease

Question 27

Differential diagnosis: Common metabolic causes for loss of balance and falls

Answer 27

Diabetic neuropathy

Question 28

Differential diagnosis: Common vascular causes for loss of balance and falls

Answer 28

CVA
Orthostatic hypotension (postural hypotension)

Question 29

History taking questions for a elderly patient who has had previous falls

Answer 29

1. Falls or near falls?
2. Where?
3. What happened immeditaly preceding fall?
4. Was it witnessed?
5. Were you able to get up after?
6. Environment - slip, trip
7. Other factors such as lighting, rushing, footwear, walking aids

Question 30

Picture of SHOE that has good support

Answer 30

Supportive collar
Low heel
Beveled heel

Buckle mechanism
Firm mid sole
Slip resistant sole