Falls

Question 1

What is the definition of a fall?

Answer 1

Event which causes a person to unintentionally rest on the ground or lower level;

Question 2

What are the 3 classifications of falls?

Answer 2

Anticipated
Unanticipated
Accidental

Question 3

What is an accidental fall?

Answer 3

Fall due to environmental hazards or external factors

Question 4

What is an anticipated fall?

Answer 4

Falls caused by known risk factors for a fall

Muscle weakness
Parkinson’s
Balance issues
Etc..

Question 5

What is an unanticipated fall?

Answer 5

Fall caused by a sudden medical event with no prior warning signs:

Stroke
Seizures
Arrhythmia (sudden)

Question 6

What are some risk factors for falls?

Answer 6

Age
Visual impairment
Hearing / balance impairment
Diseases
Medications
Substance abuse
Female
Nocturia
Diabetes
Vit D deficiency
Gait issues
Parkinson’s
Obstructive sleep apnoea

Question 7

What diseases increase the risk of falls?

Answer 7

OA
Dementia
Stroke
Postural hypotension
Arrhythmias
Vertigo
Diabetes
Parkinson’s
Obstructive sleep apnoea

Question 8

Why do patients with diabetes have a higher risk of falling?

Answer 8

Hypoglycaemia
Diabetic auto neuropathy

Question 9

What medications increase the risk of falling?

Answer 9

Anti-HTN
Tamsulosin
Opioids - drowsiness
Benzodiazepines
Anticonvulsants
Antiparkinsonian
Digoxin
Diuretics
NSAIDs

Question 10

What are the complications of falls?

Answer 10

Fractures
Rhabdomyolysis (AKI)
Laceration
Subdural haemorrhage
Immobilisation
Deconditioning
Pressure ulcers
Infections (HAP)
Fear of falling
Increase dependency
Anxiety depression
Social isolation + withdrawal

Question 11

How would you structure a history for a patient who has had a fall?

Answer 11

Pre fall
Fall
Post fall

Question 12

What are so questions you want to ask the patient pre-fall?

Answer 12

Did you know you were going to fall?
Dizziness?
SOB?
Chest pain?
Palpitations?
Muscle weakness?
Slurring of speech?
Jerking?
Tongue biting?
Where were you?

Question 13

What are some questions you are going to ask a patient about the fall stage?

Answer 13

How did you fall?
How did you land?
Did you hit your head?
Any LOC?

Question 14

What are some questions you are going to ask a patietn post fall?

Answer 14

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?

Question 15

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?

Answer 15

Previous falls?
PMH
Medications they’re on
Functional hx (ADLs)
Social hx

Question 16

What physical examinations are you going to do on a patient presenting with a fall?

Answer 16

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

Question 17

How do you assess for postural hypotension?

Answer 17

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

Question 18

What investigations would you do to investigate a falls patient?

Answer 18

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

Question 19

Why are you doing all the investigations for a falls patient?

Answer 19

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)

Question 20

What people help prevent falls?

Answer 20

Fragility specialist nurses
OT
Physiotherapists
Pharmacists
Social care workers
Family
Volunteers
Elderly care specialists

Question 21

What systems are often reviewed to assess falls risks?

Answer 21

Gate, mobility and balance
Visual and hearing
Cognitive and neurological
CVS
Med review
Urinary and faecal continence
Osteoporosis
Functional ability and confidence

Question 22

What is the first line medication for treating postural hypotension?

Answer 22

Fludrocortisone

Question 23

What medication is given for a patient with postural hypotension if fludrocortisone doesn’t help?

Answer 23

Midodrine

Question 24

How do we prevent falls?

Answer 24

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