Falls

Question 1

3 main Hx questions for falls

Answer 1

1. Why did you fall?
2. Any injuries?
3. Falls risk factors

Question 2

Are there any routine Ix for falls?

Answer 2

No - depends on clinical picture

Question 3

What are the main complications of falls?

Answer 3

• Fractures
• Long lie injury (muscle breakdown – rhabdo, pressure ulcer) → personal alarms
• Fear of falling: end of up de-conditioning if they do not move (cycle of falling)

Question 4

What are the 3 main balance assessment tests?

Answer 4

1. Romberg’s Test: close eyes and balance for 1 minute (feet apart, together or tandem depending on pt)
   +ve: large external movement, stepping out, opening eyes
2. Sternal Push or shoulder tug: pull on shoulders from behind with pt standing
   +ve if step back more than 2 steps
3. Timed up and go: time get up from chair, walk 3m and back.
   + ve compare with standardised mean times with age

Question 5

Falls education: how to get up after fall

Answer 5

Roll over onto all 4s, crawl up to chair, push up with less affected leg.

Question 6

List exercise interventions available for the prevention of falls

Answer 6

Exercises (supervised and/or unsupervised)

1. Gait, balance and functional training
2. Strength/resistance
3. Flexibility
4. 3D e.g. Tai Chi, Qi Gong, dance
5. General physical activity
6. Endurance
7. Other

Question 7

Intrinsic Risk factors of falls

Answer 7

• Gait & balance impairment 
• Peripheral neuropathy
• Vestibular dysfunction 
• Muscle weakness
• Vision impairment
• Medical illness
• Advanced age
• Impaired ADL
• Orthostatic hypotension 
• Dementia
• Drugs

Question 8

Extrinsic risk factors of falls

Answer 8

• Environmental hazards
• Poor footwear
• Restraints

Question 9

Precipitating cause of falls

Answer 9

Precipitating Causes
• Trips & slips
• Acute medical illness 
• Drop attacks
• Syncope
• Dizziness

Question 10

What is the one intervention that is beneficial in all settings (hospital and community)?

Answer 10

EXERCISE!