Falls Flashcards
investigations and examinations in falls
neurological - upper, lower, CN cognition: AMT, CAM, MMS lying and standing BP cardiorespiratory: AF, arrhythmia, HF MSK
bloods: FBC: infection and anaemia U&Es: dehydration, electrolyte imbalance TFTs: peripheral neuropathy B12: peripheral neuropathy Folate: peripheral neuropathy bone profile: osteoporosis
if signs of infection on FBC, MSU, CXR, cultures
ECG: arrhythmia, AF
xray any injuries
head injury or decreased GCS - CT head
echo if suspecting aortic stenosis, hypertrophic obstructive cardiomyopathy
management of falls
1) screen all patients for osteoporosis - FRAX tool
alendronic acid and vitamin D and calcium therapy
2) strength and balance training
3) home hazard intervention
4) vision assessment and intervention/referral
5) medication review
6) check other conditions are well controlled
causes of fall
DAME
D - drugs: polypharmacy, antihypertensives, sedatives, opioids
A - ageing: vision changes, cognitive decline, gait abnormalities, OA
M - medical causes: hypotension, arythmies, PD, strokes, neuropathy, cataracts
E - environmental: walking aids, footwear, home hazards
Differentials for feeling dizzy
Vertigo: room spinning
BPPV - short spells <1 min settle spontaneously and occur when moving head (Dix Hallpike manoeuvre), meniere’s, vestibular, neuritis, acoustic neuroma
migraine, brainstem ischaema, cerebellar stroke, MS
presyncope: feeling faint or light headed often when standing or seated associated with pallor relieved by lying postural hypotension is common
unsteady:
general feeling of unsteadiness or feeling unbalances the usually comes from patients legs rather than their head
psychogenic
fear of falling, loss of confidence, anxiety,
how to screen for osteoporosis
FRAX
ten year fracture risk
age, sex, weight, height, previous fracture, taking steroids, RA, smoking, alcohol
Treatment of osteoporosis should be considered for patients with low bone mineral density (a T-score of between −1.0 and −2.5) as well as a ten-year risk of hip fracture of ≥3% or a ten-year risk of a major osteoporosis-related fracture of ≥20% as assessed with the FRAX.
risk factors for osteoporosis
previous fracture smoking alcohol glucocorticoids RA BMD
treatment for osteoporosis
alendronic acid - 70mg once weekly
vitamin D and calcium therapy
