Falls Flashcards
environmental risk factors
poor lighting rugs stairs pets incorrect walking aids
Medication risk factors
psychotropic: sedaive, opiates, antidepressants, antihypertensives, nitrates
anti-arrhythmic- beta-blockers, digoxin, flecanide
steroids
diabetic drugs
cardiovascular risk factors
syncope
orthostatic hypotension
what key investigations to assess fall risk
- lying and standing BP (OH)
- 24hr ECG monitoring- syncope
- timed get up and go
Management of falls
- strength and balance retraining
- reduction in psychotropic medications
- reduce home hazards and consider aids
- calcium and vitamin D supplements
why is NOF more common in the elderly?
bone strength is often compromised by osteoporosis
- higher risk of falls
how does NOF present?
usually pain with externally rotated and shortened hip
but might not if cognitive impairment
Immediate management of NOF
- adequate analgesia
- iv fluids
- identify infection
- if medically stable operate withing 48hrs
what is post op confusion exacerbated by
pain, infection, opiods (sedation), constipation, electrolyte abn
prevention of NOF
Calcium and vitamin D supplements
oral bisphosphonates if osteoporosis
side effects of bisphosphonates
- oesophageal ulceration
- GI bleeding
- avascular necrosis of jaw
- atypical femur fracture
investigations in NOF
- MRI hip (if not available CT)
- FBC, LFTs, Ca, PTH, glucose
recommended use of bisphosphonates in women according to age (secondary prevention NOF)
if >75- don’t need DXA- start aledronate
if 65-74 if DXA t score