Falls

Question 1

What are the risk factors for falls?

Answer 1

Previous falls
Fear of falling: more anxious, leads to behaviours that increase risk
Balance problems: Parkinson’s disease-neuromuscular/arthritis, sarcopenia=poverty of the flesh
Pain: can cause delirium, OA
Drugs: anti hypertensives eg diuretics- lead to postural hypotension, alpha blockers, drowsy eg anti-depressants, opiates, REMEMBER big cause of delirium is anti-cholinergic drugs, (eg amitriptyline) dehydration
Cardiovascular conditions: TLOC eg syncope, aortic stenosis
Cognitive Impairment: Put yourself in risky situations
Uriinary incontinence: slip in own urine, urgency
Stroke
Diabetes: peripheral neuropathy, hypo, vision
Environment

Question 2

What do you examine for after a fall?

Answer 2

-ASIs, sacrum and buttocks look for pressure sores
-Head injury-lacerations
-ROM to hips-hip fractures
-CVS exam- lying and standing BP, carotid sinus massage, listen out for AS
A systolic drop of 20-30mmHg indicate postural hypo
-Resp exam: infection
-leg: strength, reflexes, sensation- cogwheel rigidity+ resting tremor+ poverty facial expression
-Feet: ischaemic and cellulitis
-Note arthritis

Question 3

What investigations do you do for a fall?

Answer 3

• Bloods: U+Es (electrolytes, creatinine), FBC (anaemia, WBC), blood glucose, LFTs, CRP, B12 and folate (peripheral neuropathy), TFTs, calcium phosphate
• ecg: arrhythmia
• Urine dipstick

Question 4

What is the management for a fall?

Answer 4

• Withdraw benzodiazepines if on
• lifestyle- get up slowly etc.
• visual assessment
• home hazard assessment- OT
• Lower limb strength- 12 week programme

Question 5

What tests should be done for OP post fracture?

Answer 5

In women aged under 75 a DEXA Scan is indicated along with Calcium and Vitamin D blood tests to assess for deficiency.
In women over 75 with a vertebral/ hip # a presumptive diagnosis of Osteoporosis is made.

Question 6

What is the T score cut off for OP? what about osteopenia?

Answer 6

les than -2.5

-1 to -2.5

Question 7

What further ix should be done for someone with OP?

Answer 7

TFT, PTH, bone turnover and possible a myeloma screen, to include urine and plasma electrophoresis

Question 8

what is the mx of OP?

Answer 8

Alendronate and calcium with vitamin D were shown to be beneficial in all treatment trials to date.

2nd line: Denosumab

Question 9

What should you remmeber about vit D and alendronic acid tablets?

Answer 9

Remember that Alendronic acid is usually administered once a week. 30 minutes before breakfast with a full glass of water, remaining upright (sitting or standing) for 30 minutes because it can be very irritant to the oesophagus if not washed into the stomach.

ALSO vit D tablets are large and may cause non-compliance

Question 10

What areas of the body are at the most risk of #?

Answer 10

The spinal column and the hips are the most exposed bones and joints to the impact of weight of the body and vulnerable to fragility fractures.