Falls Flashcards
What is the definition of a fall?
Event which causes a person to unintentionally rest on the ground or lower level;
What are the 3 classifications of falls?
Anticipated
Unanticipated
Accidental
What is an accidental fall?
Fall due to environmental hazards or external factors
What is an anticipated fall?
Falls caused by known risk factors for a fall
Muscle weakness
Parkinson’s
Balance issues
Etc..
What is an unanticipated fall?
Fall caused by a sudden medical event with no prior warning signs:
Stroke
Seizures
Arrhythmia (sudden)
What are some risk factors for falls?
Age
Visual impairment
Hearing / balance impairment
Diseases
Medications
Substance abuse
Female
Nocturia
Diabetes
Vit D deficiency
Gait issues
Parkinson’s
Obstructive sleep apnoea
What diseases increase the risk of falls?
OA
Dementia
Stroke
Postural hypotension
Arrhythmias
Vertigo
Diabetes
Parkinson’s
Obstructive sleep apnoea
Why do patients with diabetes have a higher risk of falling?
Hypoglycaemia
Diabetic auto neuropathy
What medications increase the risk of falling?
Anti-HTN
Tamsulosin
Opioids - drowsiness
Benzodiazepines
Anticonvulsants
Antiparkinsonian
Digoxin
Diuretics
NSAIDs
What are the complications of falls?
Fractures
Rhabdomyolysis (AKI)
Laceration
Subdural haemorrhage
Immobilisation
Deconditioning
Pressure ulcers
Infections (HAP)
Fear of falling
Increase dependency
Anxiety depression
Social isolation + withdrawal
How would you structure a history for a patient who has had a fall?
Pre fall
Fall
Post fall
What are so questions you want to ask the patient pre-fall?
Did you know you were going to fall?
Dizziness?
SOB?
Chest pain?
Palpitations?
Muscle weakness?
Slurring of speech?
Jerking?
Tongue biting?
Where were you?
What are some questions you are going to ask a patient about the fall stage?
How did you fall?
How did you land?
Did you hit your head?
Any LOC?
What are some questions you are going to ask a patietn post fall?
How long were you on the ground?
Did you get up yourself?
Do you remember how you got to the floor (LOC)?
Any pain?
Bleeding?
Movements?
What questions are you going to ask a patient who’s had a fall once you’ve asked pre fall, fall and post fall questions?
Previous falls?
PMH
Medications they’re on
Functional hx (ADLs)
Social hx
What physical examinations are you going to do on a patient presenting with a fall?
Look for hydration status
Level of consciousness (4AT)
BP and. Postural BP changes
Vision + Hearing
HR and rhythm
Bruits + Murmur
Neurological exam
MSK of joints
Gait + Balance
Environment assessment
How do you assess for postural hypotension?
Lie down for 5mins then measure BP
Stand up measure BP at 1 min
Take BP at 3 mins
Asymptomatic drop of 30mmHg or more systolic = postural hypotension
Symptomatic drop of 20mmHg or more systolic = postural hypotension
What investigations would you do to investigate a falls patient?
FBC
U+ES
Random blood glucose
Thyroid function tests
B12 and folate
Vit D and bone profile
Creatinine kinase
X-ray
ECG, 24hr tape or ECHO
CT/MRI brain
DEXA scan
Why are you doing all the investigations for a falls patient?
FBC - infection, anaemia?
U+Es - hypokalaemia (muscle weakness?) hyponatraemia (confusion?)
Random BG (hypoglycaemia)
Thyroid function tests - hypothyroidism (bradycardia or muscle weakness)
B12 and folate (peripheral neuropathy)
Vit D and bone profile (osteoporosis , osteomalacia)
Creatinine kinase (rhabdomyolysis)
X-ray (chest pathology, OA?)
ECG, ECHO (Ejection fraction, valve issues)
DEXA (osteoporosis)
CT/MRI brain (subdural haemorrhages)
What people help prevent falls?
Fragility specialist nurses
OT
Physiotherapists
Pharmacists
Social care workers
Family
Volunteers
Elderly care specialists
What systems are often reviewed to assess falls risks?
Gate, mobility and balance
Visual and hearing
Cognitive and neurological
CVS
Med review
Urinary and faecal continence
Osteoporosis
Functional ability and confidence
What is the first line medication for treating postural hypotension?
Fludrocortisone
What medication is given for a patient with postural hypotension if fludrocortisone doesn’t help?
Midodrine
How do we prevent falls?
Stop unnecessary medications (STOPP-START)
Correct vision and hearing issues
Exercise
Vit D supplements
Correct footwear and walking aids
Home suitability improvements
Socialisation opportunities
Rehab
Family involvement
Follow ups
