Falls Flashcards
SE of statins and its association with falls
- myalgias
- rhabdomyolysis
- myopathy
These may contribute to a fall.
Association of ACEI & diuretic with falls
Postural hypotension
Its frequency & severity increases with age.
Association between OA of hip & falls
Antalgic gait is asymmetrical and unstable -> more prone to falls.
Association of smoking and falls
Smoking affects healing process of the bone and may cause osteoporosis which makes fractures more likely after falls
What chronic toxicities of alcohol can contribute to falls?
- cerebellar defects/toxicities
- peripheral neuropathies
- Wernicke’s encephalopathy (ataia, opthalmoplegia)
- frontal lobe toxicities -> compulsive
- Withdrawal syndrome
Examinations in a pt with a fall
- postural hypotension
- assess balance & strength
- examine any trauma from the fall
- LL neurological exam
- vision
Ix in a fall
- XR for any relevant trauma
- assess for osteoporosis e.g. DXA T score, vitamin D, calcium & phosphate.
- vitamin D (good for bone & muscle strength and hence deficiency can contribute to falls).
DXA T score is compared to 30 year old females. Z score is age-matched & is helpful when considering secondary causes.
Rx of falls
- manipulation & POP of any relevant fractures/trauma
- pain relief
- review medications
- optometry/ophthalmology review
- footwear review
- Bisphosphonate for bone health
- calcium & vitamin D supplements
- refer to physiotherapy for dynamic balance training
What does positive Romberg’s sign indicate?
Proprioception deficits (NOT cerebellar)
What are hot falls & cold falls?
Hot falls: acutely unwell but present with a fall as a non specific marker of ill health
Cold falls: generally frail older people with multiple contributory factors
Cx of “long lie”
Long lie is the period between falling & getting back up. Many elderly struggle to get up after the fall resulting in a long period of tie on the ground.
Cx: pneumonia, compartment syndrome, AKI. etc
This may lead to hospitalisations or instutionalizations.
What are falls risk factors (intrinsic, extrinsic & precipitating)?
Intrinsic
- gait & balance impairment
- peripheral neuropathy
- vestibular dysfunction
- muscle weakness
- vision impairment
- medial illness
- advanced age
- impaired ADL
- orthostatic hypotension
- dementia
- drugs
Extrinsic:
- environmental
- poor footwear
- restraints
Precipitating
- trips & slips
- acute medical illness
- drop attacks
- syncope
- dizziness
What do you want to know in a fall Hx?
- headstrike
- any trauma
- LOC (syncopal cardiac/vasovagal, seizure)
- circumstance of fall
- mechanism of fall; imbalance, musculoskeletal, mechanical, neural, cardiac
- seizure like activities
- Falls risk factors (hypo/hyperglycaemia due to diabetes, postural hypotension, visual deficits, imbalance)
