Falls

Question 1

Important risk factors for falls? (5)

Answer 1

Age
Female gender
Low weight
Polypharmacy and certain medications e.g. psychotropics
Dependency in ADLs
Cognitive impairment

Question 2

Why are falls in older people more likely to result in injury e.g. fractured NOF?

Answer 2

Bone pathology e.g. osteoporosis, bone mets

Poor protective mechanisms

Question 3

What are some of the factors in poor self protection in falls? (4)

Answer 3

Lack of subcutaneous fat
Syncopal falls
Slow and stiff joints/movements
Neurological problems e.g. reflexes

Question 4

Important aspects of the falls history? (7)

Answer 4

Pattern of the falls
What was the patient doing at the time?
Loss of consciousness?
Warning before the fall?
How did they feel after the fall?
Witnessed?
Last seen by optician?

Question 5

Body systems which can be implicated in falls?

Answer 5

Visual
Cardiovascular
Neurological 
Musculoskeletal
Vestibular

Question 6

Ways in which eyesight may be impaired?

Answer 6

Reduced acuity
Reduced visual fields
Decreased dark adaptation

Question 7

Underlying causes in elderly people:

a) reduced visual acuity
b) reduced visual fields
c) decreased dark adaptation

Answer 7

a) presbyopia; macular degeneration; cataracts
b) glaucoma, posterior circulation stroke
c) miotic agents for glaucoma

Question 8

Vestibular causes of falls? (3)

Answer 8

BPPV
Meniere disease
Labyrinthitis

Question 9

Maneuver which a) reproduces symptoms b) treats BPPV?

Answer 9

a) Dix-Hallpike

b) Epley

Question 10

Causes of peripheral neuropathy? (3)

Answer 10

Diabetic neuropathy, peripheral vascular disease, vitamin B12 deficiency

Question 11

Cardiac/circulatory causes of falls? (5)

Answer 11

Orthostatic hypotension
Aortic stenosis
Tachy or brady arrythmias
Autonomic dysfunction e.g. due to diabetes
Dehydration e.g. secondary to diuretic therapy

Question 12

Neurological causes of falls?

Answer 12

Stroke (either old or new onset)
Dementia/other cognitive impairment e.g. delirium
Movement disorders e.g. PD, cerebellar 
Vertebrobasilar insufficiency
Focal neurological deficits

Question 13

Musculoskeletal causes of falls?

Answer 13

Muscle weakness
Loss of flexibility
Pain (muscle, joint)

Question 14

Minimum investigations/procedures in falls?

Answer 14

• Medication review
• Standing and sitting BP
• Cardiac auscultation
• Cognitive assessment e.g. MMSE
• Full neurological exam including gait and balance
• Visual acuity
• ECG
• give consideration to bone protection and fracture risk

Question 15

Important risk factors for fracture? (4)

Answer 15

Increasing age
Female sex
Low body mass
Corticosteroid therapy/Cushings

Question 16

How is osteoporosis defined with reference to DEXA scan?

Answer 16

hip bone mineral density more than 2.5 standard deviations below the young adult reference mean

Question 17

Secondary causes of osteoporosis?

Answer 17

RA and other inflammatory arthropathies