Falls Flashcards
How does a history of falls lead to functional decline?
What happening as a result of a fall has the worst recovery statistics?
Increased risk of falls
Social isolation
Decreased confidence
Functional decline
Neck of femur fracture
What is syncope?
What is often the cause (generally)?
Why should you be suspicious of syncope if there are facial injuries?
What are some common causes of syncope?
A transient loss of consciousness
Cardiac
Because it suggests there has been no attempt to break the fall, so the person has lost consciousness
Arrhythmias, postural hypotension, vasovagal
Syncope with breathlessness is suggestive of what diagnosis?
If a person has a fall for an unknown reason and is found to have a murmur, what investigation should be performed?
What investigation is performed if you suspect syncope caused by postural hypotension?
What is a common cause of postural hypotension?
Aortic stenosis
ECHO
Lying and standing BP
Medications, especially anti-hypertensives
Explain how lying and standing BP is performed?
What would be a significant result?
Take 1st BP after lying for 5 minutes, take 2nd BP in the first minute of standing and then again after standing for 3 minutes
A fall in systolic BP by > 20mmHg or diastolic BP by > 10mmHg after standing for 3 minutes is diagnostic
What will vestibular disease cause before a fall?
What is a common vestibular cause of falls?
If the above diagnosis is suspected, how is it investigated for and how is it treated?
Vertigo and imbalance
BPPV
Dix-Hallipike manoeuvre for diagnosis (lie down with head rotated at 45 degrees and extended to 20 degrees, looking for rotational nystagmus to the affected side)
Epley manoeuvre for treatment
What are some common visual causes of falls?
Cataracts
Bifocal/varifocal glasses (alter depth perception)
With regards to medications, what is an independent risk factor for falls?
What are some common drugs which increase falls risk?
Polypharmacy of 4 or more meds
Benzos, neuroleptics, anti-hypertensives, anti-depressants, anti-cholinergics
If there has been a fragility fracture associated with a fall, what is the management?
Diagnose and treat osteoporosis with Ca++ and vitamin D supplements
What is the management option with the strongest evidence base for falls?
How often must this be done?
What are some other non-pharmacological management options for falls?
If present, what medications should you always consider stopping?
Strength and balance training
3 times weekly for a minimum of 12 weeks
Environmental modifications, good footwear, optimise vision
Psychoactive drugs
What are some general causes of falls, not related to any particular body system?
What are some neurological causes of falls?
What is an endocrine cause of falls?
What are some MSK causes of falls?
Mechanical, polypharmacy
Strokes, peripheral neuropathy
Hypoglycaemia
Arthritis, atrophy
