Falls Flashcards
Questions to ask before a fall
- Recent change of medications
- Palpitations
- Feeling light headed
- Move their head? Carotid sinus sensitivity
Red flags after a fall
- Loss of consciousness
- Vomiting (Raised ICP- bleed in the brain)
- Incontinence
- Seizure, tongue biting
Definition of recurrent fall
More than 2 in a year
Top tips for a fall assessment
- Look for injuries
- ECG
- Lying/standing BP
- Medication review- if they are on more than 3 for one problem, ask about compliance issues.
- Gait
- Bone health review
- Fear of falling/loss of confidence
- Exercise programme
List three fall risk assessment tools
- Timed up and go test (time >12 seconds is a high risk of falling)
- FRAX (10 year probability of a major osteoporotic fracture)
- FRAT (comprehensive assessment of falls risk- falls history, medications, sensory impairment and mobility issues)
Risk factors for osteoporosis
- Being over the age of 65
- Female
- Steroids/anti-oestrogen drugs for females
- Smokers
- Family history of osteoporosis
- Endocrine disorders
- Chronic kidney disease
Side effects of Bisphosphonates
Alendronic acid, risedronate and zoledronate
- Gastrointestinal issues (oesophagitis and nausea)
- Osteonecrosis of the jaw
- Atypical femoral fractures
Side effects of Denosumab
- Skin infections
- Hypocalcaemia
- Osteonecrosis of the jaw
Side effects of SERMs
Selective oestrogen receptor modulators - Raloxifene
- Hot flushes
- Increased risk of VTE
Why should you ask someone if they put their hand out to stop them in a fall?
Shows whether they lost consciousness or not
Risk factors for a fall in PMH
- Diabetes
- HTN
- Epilepsy
- Previous falls
- Arrhythmias
- Parkinson’s
- Stroke
- Incontinence
- Vision
- Cognitive impairment
Factors in SH that increase risk of falls
- Stairs?
- Clutter/trip hazards- pets
- Live with anyone else
- Alcohol- neuropathy, intoxication
How to examine after a fall
CVS
- Pulse, blood pressure (lying and standing), murmurs
Resp
- LRTI, COPD, atelectasis, hypoventilation- rib fracture
Abdominal
- Constipation or urinary retention- delirium, diarrhoea
Neurological
- Stroke, cerebellar signs, impaired balance, peripheral neuropathy- check gait, LOC
MSK
- Hip fracture, joint pain, weakness, arthritis
Differential diagnoses of falls
CVS
Neurological
Genitourinary
Endocrine
MSK
- Arthritis
ENT
- BPPV
