Falls

Question 1

List some causes of falling related to ageing

Answer 1

Reduced reactions
Visual impairment - smaller pupils, lens thickening
Sarcopenia
Poor sensory awareness
Decreased exercise (less fitness)

Question 2

List some cardiovascular causes of falls and syncope

Answer 2

Neurogenic (vasovagal)
Orthostatic hypotension
Arrhythmias
Valve disease (aortic stenosis)
Carotid sinus hypersensitivity

Question 3

List some musculoskeletal cause of falls

Answer 3

Joint pain
Arthritis
Sarcopenia

Question 4

List common drugs that increase the risk of falls

Answer 4

Benzodiazepines
Neuroleptics
Anti-hypertensives
Anti-cholinergics
Anti-depressants
Anti-arrhythmias (digoxin)
Opiates
Parkinsons meds
ALCOHOL

Question 5

What management has the strongest evidence for reducing falls risk?

Answer 5

Strength and balance training 3x a week for 12 weeks

Question 6

List some implications of falls

Answer 6

Hypothermia
Dehydration
Pressure sores
Rhabdomyolysis (lead to AKI)
VTE
Bronchopneumonia
Muscular deconditioning

Question 7

What is the definition of orthostatic hypotension?

Answer 7

Skeletal muscle pumps less effectively = less venous return

Reduced systolic BP by >20mmHg or diastolic BP >10mmHg after 3 minutes of standing

Question 8

What distinguishes syncope from falls?

Answer 8

Transient loss of consciousness

Question 9

List some neurological disorders that can contribute to falls

Answer 9

Cervical myelopathy (high stepping gait, romberg's +)
Cerebellar ataxia (wide-based gait, cerebellar signs)
Peripheral neuropathy (altered sensation, wide-based gait)
Parkinsons disease (shuffling gait, tremor, rigidity, bradykinesia, orthostatic hypotension)
Lumbar stenosis (pain/paraesthesia legs, gait wide-based)
Stroke disease

Question 10

What is the most common type of vestibular disease contributing to falls? How is it diagnosed and treated?

Answer 10

BPPV
Halpike manoeuvre (+ if latency of onset, rotational nystagmus - fast phase to affected side)
Epley manoeuvre

Question 11

What is vertigo? What must you always clarify with the patient?

Answer 11

Feels like your at sea, room is swimming, rotational

Clarify what they mean by dizzy

Question 12

What questions should you ask a patient regarding syncope?

Answer 12

Chest pain/ SOB (aortic stenosis)
Any prodromal symptoms (should be -)
How do they feel sitting vs. standing?

Question 13

How should you approach a falls history?

Answer 13

PREVENTION - screen for falls - 2 or more in last year? Acute fall? Problems with walking or balance?
FULL HISTORY - before and after fall? Impact/consequence of fall? Witness account? Accurate medication list?

Question 14

What investigations should be considered in falls?

Answer 14

Gait, balance, joints
Neurological (vestibular, cerebellar, peripheral, rombergs, extrapyramidal, cortical)
CVS (pulse, murmurs, lying and standing BP)
Visual acuity (Snellen chart)
Feet and footwear
Incontinence assessment

Question 15

What assessment tools can be used in falls?

Answer 15

Timed up and go test
Berg balance scale
Tinetti score

Question 16

What should always be assessed in falls with elderly patients?

Answer 16

Fracture assessment (Q fracture)
Vit D deficiency
Fragility fracture e.g. wrist (osteoporosis)

Question 17

A patient on > _ medications is a risk for falls?

Answer 17

4

Question 18

What is some management options in postural hypotension?

Answer 18

Increased salt

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