Falls

Question 1

Normal gait physiology

Answer 1

The neurological system: basal ganglia and cortical basal ganglia loop
The musculoskeletal system
Effective processing of the senses such as sight, sound, and sensation (fine touch and proprioception)

Question 2

Risk factors

Answer 2

Previous fall (MC)
> 65
Poly pharmacy
Postural hypotension
Cognitive impairment
Vision problems

Question 3

Medications that cause postural hypotension

Answer 3

Nitrites
Diuretics
Anticholinergic meds
Antidepressant
Beta-blockers
L-dopa
ACE-I

Question 4

Medications associated with falls due to other mechanisms

Answer 4

Benzodiazepines
Antipsychotic
Opiates
Anticonvulsant
Codiene
Digoxin
Other sedative agents

Question 5

Risk assessment questions

Answer 5

• Where was the patient when they fell?
• When did they fall?
• Did anyone else see the patient fall? (collateral history)
• What happened? Were there any associated features before/during/after
• Why do they think they fell?
• Have they fallen before?
• Systems review
• Past medical history (especially issues related to balance/sight/gait)
• Social history

Question 6

Investigations

Answer 6

BP
Blood glucose
Urine dip
ECG
Bloods: FBC, U+E, LFT
X-ray of chest/injured limbs, CT head and cardiac echo

Question 7

Frailty measurement

Answer 7

Assessed through the evaluation of gait speed, self-reported health status, or the PRISMA-7 questionnaire: The PRISMA-7 involves questions considering the age, sex, health problems, assistance required and walking aid use of the patient