Falls Flashcards
Why do falls impact the individual?
Pain
Injuries
Loss of confidence
Loss of independence/mobility
Mortality
What are the impacts of falls on society?
High cost to the NHS
High workload for social workers/physio/OT teams
Risk of falls - isolated elderly
What are some common causes of falls in the elderly?
Cardiac - arrhyhtmia/orthostatic/hypotension/bradycardia/valvular disease
Chest infection
UTI
Diarrhoea/constipation
Polypharmacy
Mechanical - poor footwear/visual or hearing impairment
Stroke/peripheral neuropathy
Arthiritis
What promodoral signs are important to ask about for a fall?
Warning signs
Dizziness/chest palpitation or pain
Fallen before
What signs is it important to ask about during a fall?
Incontinence or tongue biting
Loss of consciousness
Change in colour
Injuries
What part of body hit the floor first?
remember hitting the floor/falling
What is important to ask about the events that happened after that fall?
What happened?
How long on the floor for?
Behaviour - delirium etc
Confusion? - head injury
Any weakness or speech difficulty??
Is patient weight bearing
What medications commonly prescribed to the elderly can increase the risk of falls?
Beta blockers - bradycardia
Diabetic medications - hypos
Antihypertensives - hypotension
Benzodiazepines - sedation
Antibiotics - intercurrent infection
What signs are important to look for in a patient after a fall?
Boggy swellings
Battles signs (mastoid bruising) and Panda eyes -> basillar skull fracture
Haemotypnaum - indicat dislocated TMJ
Lacertations
CSF leakage - through nose or ear
Facial bone asymetry.
What investigations should be done after a patient has had a fall?
Bedside: Obs - including LSBP, ECG, urine dip/culture, MMSE
Bloods: FBC, U+Es, LFTs, Bone panel, VitD, B12+folate, TFTs, coagulation + INR/CRP
Imaging: CT head, X-ray if ?fracture/infection
What are some potential management strategies after a fall in an elderly patient?
Gait and balance = physiotherapy
Visual problems = eye test
Hearing difficulties - remove wax, test
Environmental hazards = rugs
Continence - infections, pads, aids in home
medication review
postural hypos - meds and hydration
Congitive impairment - psychiatry/memory services
Alochol intake - alcohol cessation advice.
What is the Clinical Frailty Score?
Scoring system from 1 to 9 determines level of support patient requires
Based on mobility, co-morbidities, mental status etc.
What are the different stages on the clinical fragility score?
1 = very fit = robus, energetic and motivated = commonly exercise
2 - well - no active disease, active occasionally
3 - managing well - medical problems are well controlled - not regularly active
4 - vulnerable - not dependent but limited activities due to symptoms
5 - mildly frail - require help in high order ADLs. tends to progressively impair patients
6 - moderately frail - help with all outside activities and keeping house (bathing, stairs)
7 - severely frail - completely dependent for personal cause, no risk of dying
8 - very severely frail - depdent and tend to be approaching end of life, may not recover from minor illness
9 - terminally ill - all people with life expectancy less than6 months regardless of other fragility factors
What is the orthogeriatric service?
Specialises in the treatment of complex, frail, elderly patients with orthopaedic problems such as NOF fracture.
Specialise in bone health and falls prevention.
Liase with surgeons, anaesthetics, physio, OT to ensure best rehab after surgery.
