Falls Flashcards
Explain how you would take a falls history.
State what questions you would ask.
**Presenting Complaint: **
- Tell me about this fall/ whats brought you in?
Before the Fall:
-When did this fall occur? Days, weeks etc
-What time of day was it?
-Talk me through what you were doing before you fell
-How did you feel before the fall?
-Did you feel dizzy or lightheaded before you fell?
During the Fall:
-How did the fall happen? E.g. trip on a rug or loose
conciousness
-Where did you fall? e.g inside, outside.
- Did you hit your head or any other body part?
-Did anything break your fall?
-How and where did you land?
-Did you lose conciousness?
**After the fall: **
- Were you able to get back up on your own?
-Were you on the floor for sometime?
-Did someone come to help you?
-How did you feel after the fall?
-Did you have any pain or symptoms of dizziness or sickness?
Now:
-How are you feeling now?
-Do you have any injuries or bruising?
-Do you have any pain?
-How have things been since the fall?
-Have you had any falls since then?
-Are you worried about falling again?
Past Medical History:
- Any current medical conditions? E.g diabetes, cardiac conditions
-Any previous surgeries?
Drug History:
- What medications do you currently take?
(Think sedatives, cardiac medications, anticholinergics, hypoglycaemics, opiates that can contribute to falls.)
- Any over the counter e.g. antihistamines
- Any herbal remedies?
-Any drug allegeries or other allergies?
Social History:
-How do you normally mobilise?
-Do you use any walking aids?
-How do you manage with ADLs?
-Do you live with anyone/anyone at home?
-What type of accomodation do you live in? any stairs or steps
-Do you smoke or drink alcohol?
-Do you wear glasses?/How is vision.
**Family History: **
-Any medical conditions which run in the family?
(Think any cardiac conditions or nervous system autoimmune conditions)
List 4 types of falls
1-Syncopal fall
2-Non-syncopal fall
3-Simple fall
4-Multi-factorial fall
What is the difference between a syncopal and non syncopal fall?
A syncopal fall refers to the loss of conciousness during the fall e.g. fainting whereas in a non syncopal fall conciousness is not lost.
What is the difference between a simple and multi-factorial fall?
A multifactorial fall is a fall which is a result of multiple factors e.g. poor lighting, loose carpets, polypharmacy, advancing age.
A simple fall is a fall which is a result of something plain & simple e.g. tripped over shoelace.
Suggest 6 factors which predispose a patient to a fall?
1-Increasing age
2-Polypharmacy
3-Underlying medical conditions e.g Cardiac or neurological conditions
4-Poor mobility, cognition and vision.
5-Unsafe enviroments e.g. loose carpets, trailing wires.
6-Alcohol or substance abuse
Why does increasing age increase the risk of falls?
Suggest 3 reasons.
1-Decline in proprioception and bodies ability to respond to where it is in place.
2-Loss of muscle mass, strength & balance
3-Decline in vision
Explain why a drug history & medication review is essential in someone who has a history of falls?
The cause of the patients fall may be due to a medication they are taking or a side effect of a medication. Polypharmacy is a huge risk factor for falls. It is necessary to review the medications to see if the patient still requires each medication they are taking and to help idenitfy any medications which may have contributed to the fall, so these can be changed and thus reduce the risk of future falls.
Suggest 4 clinical assessments you may carry out in someone who has fallen?
1- A functional assessment of their mobility – how do they mobilise, what with and what is their gait like.
2- Cardiovascular examination – include an ECG and a lying and standing BP (at immediate, 3 and 5 minutes)
3- Neurological examination (cranial nerve & peripheral nerve)
4-Musculoskeletal examination – assess their joints
What investigations would you peform for someone who has fallen?
**Bedside: **
-Full set of observations
-Lying & standing BP
-ECG
-Urine dip
-Urine MCS
-Cognitive assessment (AMT)
-Blood glucose
Bloods:
-FBC
-U&Es
-LFTs
-Clotting Profile
-CRP &ESR
-Bone profile (calcium)
Imaging:
-Chest X-ray
-CT head
-Echo +/-
Other:
-48hr Cardiac monitoring tape
Name 3 fall risk assessment tools?
1- Falls Risk Assessment Tool (FRAT)
2-STEADI (Stopping Elderly Accidents, Deaths, and Injuries)
3-Time up and Go (TUG) test
What are fall prevention strategies and how do they reduce falls?
Simple tips or aids to help prevent or reduce falls.
Suggest 6 examples of fall prevention strategies?
1-Non-slip mats
2-Making sure all rooms, passages and staircases are well lit.
3-Removing clutter, trailing wires and frayed carpet.
4-Beds low to the floor
5-Using a call bell for assitance to mobilise
6-Use of mobility aids
Which allied healthcare professionals may be included in the care of a patient with a history of falls and why?
1-Doctors- identify cause of fall and review patients health and any injuries. Refer to falls clinic.
2-Nurse- help with investigations and care of patient
3-Physiotherapist- assess pt for risk of falling, if they are safe to mobilise, if they require mobility aids or footwear.
4-Occupation therapists- home assessment, assess if its safe, or if things need to be put in palce e.g. grab rails, ramp.
5-Pharmacists- review medications which may have contributed to the fall.
6-Social prescribers-identify groups which may help the patient with confidence
7-Carers- assist with ADLs if necessary.
What is a falls clinic?
A clinic whihc provides assessment, advice, exercise, and strength and balance groups for older people who are at risk of falling.
Encourages patient show to ‘fall’ safely and works on improving their confidence too.
What is a bone health assessment?
A bone health assessment is series of investigations to assess your bone health and risk of osteoporosis and potential fractures.
