Falls

Question 1

What percentage of people over 80 fall every year?

Answer 1

50%

Question 2

What sort of thing happens after a fall as a consequence?

Answer 2

Pain
Injury
Distress
Loss of confidence and independence

Question 3

What implications are there of falls?

Answer 3

Death
Institutionalisation
Fracture or other injury

Question 4

Name some conditions linked to immobilisation.

Answer 4

Hypothermia
Dehydration
Pressure sores
Rhabdomyolysis
DVT
Pneumonia

Question 5

History of falls….

Answer 5

Increases risk of falls

Question 6

Women fall more than men?

Answer 6

True

Question 7

Falls are multifactorial?

Answer 7

True

Question 8

What is sarcopenia?

Answer 8

Loss of muscle mass and function with age

Question 9

What happens to the eyes with age?

Answer 9

Pupils get smaller and lens gets thicker

Less light

Question 10

What should you be suspicious of if a patient has facial injuries?

Answer 10

Syncope

Question 11

List some common causes of syncope.

Answer 11

Arrythmias
Postural hypotension
Heart block
Valvular disease e.g aortic stenosis

Question 12

Define postural hypotension.

Answer 12

Fall in SBP >20mmHg or DBP >10mmHg after 3 minutes of standing

Question 13

List some neuro conditions that cause falls.

Answer 13

Stroke, peripheral neuropathy, Parkinson’s, lumbar stenosis

Question 14

How can vestibular disease cause falls?

Answer 14

Patient has vertigo, can be dizzy and imbalanced e.g BPPV

Question 15

What kind of glasses lens has a higher risk of falls?

Answer 15

Bifocal

Question 16

Name some extrinsic factors of falls.

Answer 16

Alcohol
Medication
Footwear
Environmental hazards

Question 17

Polypharmacy of how many drugs is a risk factor?

Answer 17

4 or more

Question 18

Name some drugs that increase the risk of falls.

Answer 18

Benzodiazepines
Neuroleptics
Antihypertensives
Anti-depressants

Question 19

What points must you cover in a falls history?

Answer 19

The fall - before and after
Injuries
Witnesses
Medications

Question 20

What questions should you ask to prevent more falls?

Answer 20

Have they fallen twice in the last 12 months?
Do they have walking or balance problems?
Have they ever presented acutely with a fall?

Question 21

What should be covered in the exam?

Answer 21

Gait and balance
CVS
Neuro
Vision (Snellen chart)
Footwear
Incontinence assessment

Question 22

What should be included in CVS exam?

Answer 22

Pulse - rate and rhythm
Murmurs
Lying and standing BP

Question 23

How is a lying and standing BP taken?

Answer 23

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

Question 24

What symptoms must be recorded while taking BP?

Answer 24

Dizziness, light headedness, pallor, vision change, palpitations, feeling weak

Question 25

What is the gold standard treatment for falls?

Answer 25

Strength and balance training

3x a week for a minimum of 12 weeks

Question 26

List other interventions.

Answer 26

Good footwear
Environment modifications
Visual optimisation
Patient eduction

Question 27

What should you always consider in an elderly person?

Answer 27

Calcium/vitamin D deficiency causing weakness

Question 28

What other assessment should be done?

Answer 28

Fragility fracture assessment