Falls Flashcards
What are the intrinsic RFs for falling?
Female gender Neurological disease Cognitive decline Visual deficit Muscle weakness
What are the extrinsic RFs for falling?
Walking aids Footwear Home hazards Polypharmacy Bifocals
How common are falls?
one in three over 65s
50% of of over 80s
What are the cost of falls to the UK?
£2.3 billion per year
What is the best predictor of future falls?
> 2 falls in the last year is the best predictor of future falls risk
What are the important factors in a falls history?
long one
- collateral history
- symptoms suggestive of vertigo or syncope - do you have the same dizziness when you’re sitting down?
- drug history - polypharmacy is a RF
- ask about comorbidities
- ask about eyesight
- check pain
- check for fear of falling
- check ADLs
- ask about previous falls
- distinguish preceding symptoms - dizziness
- systems review - vision, cognition, continence
Osteoporosis RFs
Describe the examination of a falls patient
long one
‘head to toe’ approach
- Maintaining upright posture
- vision
- vestibular system
- proprioception
- cognition
- effector mechanisms
- blood pressure
- CV exam - e.g. assessment of rhythm, evidence of ejection murmur - syncope?
- Neurological examination and gait assessment
- MSK system
- footwear and walking aids
What imperative investigations should be carried out?
ECG - rule out arrhythmia
Lying and standing BP - drops of 20 (systolic) and 10 (diastolic) are significant is associated with symptoms
What other investigations should be carried out?
FBC, Yes, CK, bone biochemistry, TFTs, echo, tilt table testing, 24 hour tape
How are falls managed?
Multifactorial approach
- correct reversible medical pathologies
- review meds
- conducting strength and balance training
- home hazard assessment
How is orthostatic hypotension managed?
If persists after medication review - lifestyle advice is mainstay of management - adequate hydration - salt intake - graded standing - compression stockings - avoiding harm and crowded environments - limited evidence for drug therapy -
How can physio be used in falls prevention?
- exercises must be adapted to needs if individual patients
- they should challenge both muscle strength and balance in standing position
- should be undertaken twice a week
- total programme should exceed 50 hours
How are OTs used in falls prevention?
Home hazards assessment
Describe the medical review of a patient with falls
- optimise medical comorbidites
- diagnose new medical conditions
- medication review
- manage postural hypotension
- cognitive screening
- bone health assessment
- referral for cataract surgery if necessary
What are the consequences of falling?
loss of confidence
serious injury
fragility fracture
complications from a long lie
