Falls Flashcards
What percentage of people over 80 fall every year?
50%
What sort of thing happens after a fall as a consequence?
Pain
Injury
Distress
Loss of confidence and independence
What implications are there of falls?
Death
Institutionalisation
Fracture or other injury
Name some conditions linked to immobilisation.
Hypothermia Dehydration Pressure sores Rhabdomyolysis DVT Pneumonia
History of falls….
Increases risk of falls
Women fall more than men?
True
Falls are multifactorial?
True
What is sarcopenia?
Loss of muscle mass and function with age
What happens to the eyes with age?
Pupils get smaller and lens gets thicker
Less light
What should you be suspicious of if a patient has facial injuries?
Syncope
List some common causes of syncope.
Arrythmias
Postural hypotension
Heart block
Valvular disease e.g aortic stenosis
Define postural hypotension.
Fall in SBP >20mmHg or DBP >10mmHg after 3 minutes of standing
List some neuro conditions that cause falls.
Stroke, peripheral neuropathy, Parkinson’s, lumbar stenosis
How can vestibular disease cause falls?
Patient has vertigo, can be dizzy and imbalanced e.g BPPV
What kind of glasses lens has a higher risk of falls?
Bifocal
Name some extrinsic factors of falls.
Alcohol
Medication
Footwear
Environmental hazards
Polypharmacy of how many drugs is a risk factor?
4 or more
Name some drugs that increase the risk of falls.
Benzodiazepines
Neuroleptics
Antihypertensives
Anti-depressants
What points must you cover in a falls history?
The fall - before and after
Injuries
Witnesses
Medications
What questions should you ask to prevent more falls?
Have they fallen twice in the last 12 months?
Do they have walking or balance problems?
Have they ever presented acutely with a fall?
What should be covered in the exam?
Gait and balance CVS Neuro Vision (Snellen chart) Footwear Incontinence assessment
What should be included in CVS exam?
Pulse - rate and rhythm
Murmurs
Lying and standing BP
How is a lying and standing BP taken?
1st BP: taken after lying for at least five minutes
2nd BP: taken after standing in the first minute
3rd BP: taken after standing for three minutes
What symptoms must be recorded while taking BP?
Dizziness, light headedness, pallor, vision change, palpitations, feeling weak
What is the gold standard treatment for falls?
Strength and balance training
3x a week for a minimum of 12 weeks
List other interventions.
Good footwear
Environment modifications
Visual optimisation
Patient eduction
What should you always consider in an elderly person?
Calcium/vitamin D deficiency causing weakness
What other assessment should be done?
Fragility fracture assessment
