Falls Flashcards
What should you ask in a Falls history? (5)
Previous falls Circumstances surrounding fall Preceding symptoms Vision, continence, cognition Osteoporosis risk factors
What do you need to find out about the fall itself?
Before - Where was the person? What time of day was it? Is there a pattern to the falls? Did they have any symptoms before falling? Why do they think they fell?
During - did they lose consciousness? Have they injured themselves?
After - How did they get help? Were they able to get up, have they suffered any complications (long lie, fracture, head injury)?
What is the etiology of falls?
‘DAME’
Drugs
Aging
Medical Causes
Environmental
What do you look for in examination?
Any injuries, Vital signs (+RR), Conjuctivae for severe anaemia, chest, abdomen, basic neurology, lying and standing BP, watch the patient walk
What tests would you perform?
ECG, Urine Dip, FBC, U and Es, Glucose, CRP
What are common precipitating factors?
Infection, haemorrhage, ACS, metabolic disturbance
When do you refer to a Geriatrician?
- Abnormal gait and balance that requires diagnosis
- Possible LoC
- When medical conditions contributing to fall could be optimised
- Recurrent unexplained falls
What examinations would you perform?
Neuro Cognition - abbreviated mental test, confusion assessment, MMSE Vision Vestibular - Dix-Hallpike Cardiorespiratory BP - lying + standing MSK - joints, RoM, Gait
What initial investigations would you carry out?
FBC, U&Es, bone profile
TFTs/B12/Folate
ECG
What are the NICE best interventions for falls? (4)
- strength and balance training
- home hazard assessment and intervention
- vision assessment and referral
- medication review with modification/withdrawal
How is osteoporosis diagnoased?
Assessment of bone mineral density by axial dual-energy x-ray absorption (DEXA)
How is fracture risk assessed
FRAX score
What is 1st line treatment for osteoporosis?
Bisphosphonate (Alendronic acid 70mg OD) and calcium and vitamin D supplements
How do you manage a patient >65 who presents with a fall?
History Medication Examination Lying and standing BP Get-up-go test
What is the get-up-go test?
simple screening test for gait and balance abnormalities
