Falls Flashcards
What does a falls history taking comprise of?
- what, when + where?
- memory: do they know what happened, do they remember fallings (conscious/unconscious)
- witnessed/unwitnessed
- what happened before, during + after?
- dizziness/lightheaded ness
- cardiac symptoms?
- any weakness
- history of falls?
- how do they mobilise normally
- living situation: care home/live alone/carers
- PMH
- medications
- collateral history if possible
What medications may contribute to falls?
sedatives
cardiac meds
anticholinergics
hypoglycaemic agents
opiates
antihypertensives (if dose is too high)
What drugs are anticholinergic?
- antihistamines
- antimuscarinics
- antidepressants
- antiemetics (some)
- antipsychotics
What is needed in an examination of a patient presenting with a fall?
- lying + standing BP (immediate, 3mins + 5 mins)
- neurological exam
- cardiac exam incl. ECG
- MSK exam to assess joints + power
- functional assessment of mobility
What is postural hypotension?
drop of 20 systolic or 10 diastolic with symptoms
What risk must patients with falls be assessed for?
osteoporosis
Management of osteoporosis
- bisphosphonates e.g. alendronic acid + vitamin D
- denosumab (mab) or teriparatide (PTH analog) second line
- increase calcium intake
- weight bearing exercises + strength training
- fall prevention
Possible GI causes of a fall
Constipation
Diarrhoea
Abdominal pain
Possible respiratory causes of a fall
Breathlessness
Cough
Possible CVS causes of a fall
Chest pain
Palpitations
Arrhythmias
Possible neurological causes for a fall
Confusion
Change in sensation
Abnormal movements
Possible MSK causes for falls
Joint pain
Muscle weakness
Possible genitourinary causes of falls
Dysuria
Frequency
UTI
Nocturia
Urinary incontinence
Possible head and neck causes for a fall
Vertigo
Change in eyesight
What two groups can falls be put into?
syncopal vs non-syncopal
