Falls

Question 1

When an older person cannot get up after a fall what are some of the common complications?

Answer 1

Dehydration, hypothermia, pressure sores and pneumonia

Question 2

What are the three main groups that falls can be categorized into?

Answer 2

fall due to acute illness, single/accidental fall, recurrent falls.

Question 3

Aside from diagnosing the relevant medical conditions what are the other main components of a falls risk assessment?

Answer 3

Vision assessment, medication modification, muscle strength and balance training and assessment of home hazards

Question 4

What are some typical fall related conditions that can be found watching a patient walk?

Answer 4

Previous stroke, peripheral neuropathy, Parkinsonism, severe arthritis, cerebellar or vestibular issues, foot drop

Question 5

What is the get up and go test?

Answer 5

The patient is asked to rise from a chair (if possible without using their arms) walk three meters turn around, walk back to the chair and sit down again

Question 6

What are the two main indications to consider syncope when assessing falls?

Answer 6

The patient cannot explain the fall or does not remember hitting the ground

Question 7

Carotid sinus massage and tilt testing are what kind of falls investigation?

Answer 7

Syncope investigations

Question 8

What are the three types of lightheaded sensation associated with falls?

Answer 8

Light headed/not right on standing/walking around, vertigo and fuzzy all the time.

Question 9

What are hypoglycemia and cardiac arrhythmia examples of in relation to falls?

Answer 9

Posture independent causes of lightheaded sensation

Question 10

When patients explain the feeling of postural hypo-tension what expression aside from light headed is used frequently?

Answer 10

They feel “not right” or “off balance”

Question 11

When should postural hypo-tension be suspected?

Answer 11

When the light headed symptoms occur mainly when the patient stands up or is walking around Also if the patient has low blood pressure or is taking anti-hypertensive medication

Question 12

What does the term vertigo refer to?

Answer 12

Sensation of movement in any direction (not just a spinning sensation)

Question 13

What type of vertigo is indicated by brief vertigo on looking up?

Answer 13

Vertebrobasilar insufficiency

Question 14

What are the four main types of vertigo associated with falls

Answer 14

Benign paroxysmal positional vertigo, Vestibular neuronitis, Endolymphatic hydrops (Menieres syndrome) and decompensated vestibular disorder

Question 15

Characterize benign paroxysmal positional vertigo

Answer 15

Brief (in the range of seconds) vertigo after turning head in a certain position usually upwards e.g. lying flat or looking up towards shelves. can also present with balance problems and falls

Question 16

Characterize Vestibular neuronitis

Answer 16

Acute onset and lasts several days. Sometimes follows a short time after a viral infection. No other neurological symptoms or signs present except horizontal nystagmus. No other ear symptoms

Question 17

Characterize Endolymphatic hydrops (Meniere’s syndrome)

Answer 17

Can be idiopathic (Meniere’s) or secondary to auto immune disease, hypothyroidism and other conditions. Causes recurrent episodes of vertigo that last several hours and can be incapacitating. Is associated with hearing loss and tinnitus in one or both ears

Question 18

Characterize Decompensated vestibular disorder

Answer 18

Brief vertigo on turning in any direction/ general unsteadiness and possibly falls. Can follow stroke, vestibular neuronitis or Menieres which never fully recovered.

Question 19

What are the two main considerations for unsteadiness characterized as “fuzzy all the time”

Answer 19

Diffuse cerebrovascular disease or medication related (often anti- epilepsy medication)

Question 20

What is needed to confirm postural hypo-tension

Answer 20

A drop in blood pressure of either 20mmHg systolic or 10mmHg diastolic

Question 21

What factors related to blood volume contribute to postural hypo-tension

Answer 21

Dehydration (can be caused by vomiting diarrhea, fever, heat related illnesses and medications such as diuretics) Blood loss (and other forms of anemia)

Question 22

What factors related to artery and vein function contribute to postural hypo-tension

Answer 22

Drugs such as sildenfil (Viagra) Vardenafil (Levitra) and Tadalafil (Cialis) can cause blood vessel dilation. This can be compounded by vasodilators such as nitrates. Alcohol and narcotic analgesics can also contribute. Hardening of the arteries or atherosclerosis that develops with age.

Question 23

What factors related to the strength of the heart as a pump contribute to postural hypo-tension

Answer 23

Cardiac arrhythmias, congestive heart failure, myocardial infarction, myocarditis, pericarditis, valvular heart disease

Question 24

What factors related to the autonomic nervous system contribute to postural hypo-tension

Answer 24

Medications such as Beta blockers. Deterioration of the Purkinje fibres. Diabetic neuropathy. (Diabetes also brings the risk of dehydration)

Question 25

What drugs can contribute or cause postural hypo-tension

Answer 25

Alcohol, antiadrenics , antianginals, antiarrhythmics, anticholinergics, antidepressants, antihypertensives, antiparkinsonians, diuretics, narcotics neuroleptics and sedatives

Question 26

What components does one need to cover when taking a falls history?

Answer 26

Previous falls, circumstances surrounding fall, preceding symptoms, vision, cognition, continence and osteoporosis risk factors

Question 27

What does the DAME mnemonic for aetiology of falls stand for?

Answer 27

drugs, aging, medical causes, environmental

Question 28

What are the five main drug related causes of falls

Answer 28

polypharmy, antihypertensives, sedatives, opioids, psychotropics

Question 29

What are the four main ageing related causes of falls?

Answer 29

Vision changes, cognitive decline, gait abnormalities and osteoarthritis

Question 30

What are the three main environmental causes of falls?

Answer 30

Walking aids, footwear and hazards in the home.

Question 31

What are the three main medical causes of falls?

Answer 31

Cardiac (hypotension/arrhythmias) Neurological disease (parkinsons/strokes/neuropathy) and Cataracts