Falls Flashcards
Define fall
Coming to rest on a lower level, with or without LOC, not due to external force or medical problem
What questions should you ask someone who has had a fall?
- How did the fall happen?
- What were they doing at the time?
- How did they feel before the fall?
- Was there and dizziness or a lightheaded feeling?
- Did they lose consciousness?
- Did they have any cardiac symptoms?
- Are they weak anywhere?
- Has this happened before?
- How do they normally mobilise?
- What medication do they take? Think sedatives, cardiac medications, anticholinergics, hypoglycaemics, opiates that can contribute to falls
Common causes of falls?
Muscle weakness/sarcopenia
Poor balance/instability
Hypotension
Vision loss
Key investigations for underlying cause of a fall?
CGA - general frailty and functional ability
FBC - anaemia/bleeds
Lying and standing bp- orthostatic hypotension
ECG - arrhythmias
AXR- faecal impaction
CT head- subarachnoid haemorrhage
Multidisciplinary interventions for discharge post fall?
Pharmacist- review TTO
Physios - improve strength and mobility
Occupational therapists- AODL
GP follow up
Commonly prescribed drugs that increase falls risk?
Antihypertensives
Alpha blockers
Diuretics
Benzodiazepines
Define postural hypotension
Drop in systolic BP > 20 mmHg or diastolic BP > 10 mmHg within 3 mins of standing
How do you test someone for postural hypotension?
- Lie for 5 minutes
- Stand and take BP at 1 min, 3 min and 5 mins
What can cause postural hypotension?
Idiopathic
Hypovolaemia: dehydration, haemorrhage
Drugs: antihypertensives, anti-anginals, antidepressants, alcohol
Prolonged bed rest
Autonomic failure:
primary (eg MSA, PD)
secondary (DM)
How is postural hypotension managed?
- Hydration
- Review polypharmacy
- Reduce adverse outcomes from falls (e.g. fall alarm, soft flooring)
- Behavioural changes (e.g. rising from sitting slowly, calf pumping before standing)
- Compression stocking
- Fludrocortisone (poor evidence base) or Midodrine
How can you explain postural hypotension to a patient?
your heart is a pump
when you are standing, you have to pump against gravity to get the blood to your brain
so if you aren’t able to pump hard enough against gravity your brain is the first thing to go which causes these sxs (blurred vision, black spots, headache, nausea, feeling hot)
when you lie down your heart and brain are on the same level so the blood can get there more easily and you recover
so when you notice these symptoms, the best thing you can do to help your brain is to lie down
when should you refer a patient for multidisciplinary assessment by a qualified clinician after they have had a fall?
all over 65 who:
had more than 2 falls in 1 year,
a fall that requires medical treatment,
Poor performance or failure to complete the ‘Turn 180° test’ or the ‘Timed up and Go test’
list some complications of falls
trauma,
pain,
loss of confidence,
loss of independence,
distress,
mortality
what lifestyle advice should you give to someone with osteoporosis?
regular exercise to improve muscle strength,
smoking cessation,
balanced diet,
drink alcohol within recommended limits
When is bone sparing treatment recommended for those with osteoporosis?
T-score -2.5 or lower
