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Geriatrics and Integrated > Falls > Flashcards

Falls Flashcards

1
Q

What is a simple fall vs collapse§?

A

Simple fall:
Result of chronic impairment of cognition, vision, balance or mobility

Collapse:
Result of an acute medical problem such as TIA, arrhythmia, vertigo

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2
Q

What should you ask about in falls history?

A

Who When Where What happened Why How many

• Who has seen you fall?
• When did you fall?
• Where did you fall?
• What happened before, during and after the fall
• Why do you think you fell?
• How many times have you fallen over in last 6 months?
PAIN?

Systems review

PMHx

DHx

Allergies

SHx

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3
Q

What should you ask about before a fall?

A
  • Any warning
  • Any dizziness,
  • Any chest pain
  • Any palpitations
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4
Q

What should you ask about during a fall?

A
  • Incontinence, tongue biting → seizure
  • Loss of consciousness
  • Pale/flushed → Vasovagal
  • Any injury/pain?
  • What part of body made contact first
  • Head hit?
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5
Q

What should you ask about after a fall?

A
  • What happened after the fall
  • Able to get up by themselves
  • How long does it take to get up
  • Able to resume normal activites after
  • Any confusion after event → head injury
  • Weakness or speech difficulty after event? (Stroke/TIA)
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6
Q

What factors in systems review?

A

• General
o Fatigue
o Weight loss
o Fever

• CVS
o Chest pain
o Palpitations

• Respiratory
o Shortness of breath
o Cough

•	Neurological
o	LOC
o	Seizures
o	Motor or sensory disturbance
o	Higher congnitive disturbance
o	Visual disturbance

• Genitourinary
o Incontinence
o Urgency
o Dysuria

•	Gastrointestinal
o	Abdominal pain
o	Diarrhoea
o	Constipation
o	Vomiting

• Musculoskeletal
o Joint pain
o Muscle weakness

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7
Q

What factors in PMHx?

A 
•	General:
o	Visual/hearing impairment
o	Diabetes
o	Hypertension
o	Anaemia
•	CVS:
o	Arrhythmias
o	Heart failure
o	Ischaemic heart disease
o	Peripheral vascular disease

• Respiratory
o COPD

•	Neurological
o	Parkinson’s disease
o	Peripheral neuropathy
o	Stroke
o	Dementia

• Genitourinary
o Recurrent UTI
o Incontinence

• Gastrointestinal
o Diverticulitis
o Chronic diarrhoea
o Alcoholic liver disease

• MSK
o Arthritis
o Chronic pain
o Fractures

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8
Q

What factors in DHx?

A
  • Beta-blockers (bradycardia)
  • Sulfonylureas (hypoglycaemia)
  • Antihypertensives (hypotension) – ACEi, CCB, Diuretics, beta-blocekrs
  • Benzodiazepines (sedation)
  • Antibiotics (infection)
  • PD medication
  • Tricyclic antidepressants
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9
Q

What factors in SHx?

A
  • Alcohol intake
  • Smoking
  • Support at home
  • Mobility
  • Occupation
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10
Q

What are causes of falls?

A 
Syncopal:
CNMV
Cardio
Neuro
Metabolic
Vaso
Non-Syncopal
Mobility
Vision
Metabolic
Balance
Hazards
Cognitive
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11
Q

What are intrinsic risk factors for falls?

A 
•	Increasing age >65
•	Female gender
•	Previous history of falls
•	Comorbidities:
o	Orthostatic hypotension
o	Musculoskeletal disease
•	OA
•	Osteoporosis
•	Lower back pain
•	Visual impairment
•	Low systolic BP
•	Stroke
•	Cognitive impairment
•	PD
•	Gait disorder
•	Balance disorder – BPPV
•	Sensory impairments – peripheral neuropathy (diabetes, MS)
•	Syncope – cardiac arrhythmias, epilepsy
•	Incontinence – rushing to toilet
•	Medications:
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12
Q

What drugs can cause falls?

A 
o	Benzodiazepines
o	Sedative hypnotics
o	Anti-depressants
o	Anti-hypertensives
o	Anti-arrhythmics
o	Diuretics
o	Anti-convulsants
o	NSAIDs
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13
Q

What are extrinsic risk factors for falls?

A 
•	Environmental factor causing tripping or slipping or loss of balance:
o	Rugs
o	Electrical cords
o	Pets
o	Items on floor
•	Stairs
•	Irregular slippery floor
•	Bathtub
•	Poor lighting
•	Footwear
•	Low chairs
•	Snow, ice
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14
Q

What examination in falls?

A

General
MSK
CVS
Neuro

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15
Q

What general examination?

A 
•	AVPU
•	Confusion
•	Time up and go test – within 14s?
•	Turn 180 test
Feet footwear
Use of mobility aids
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16
Q

What CVS examination?

A
  • Pulse – irregular? AF? Bradycardia?
  • Lying and standing blood pressure – postural drop of 20mmHg systolic or 10mmHg diastolic within 3 minutes of standing
  • Carotid bruits?
  • Murmurs? Aortic stenosis/regurgitation, mitral stenosis
17
Q

What Neurological examination?

A 
•	Cognition
o	Sensation
o	Proprioception
o	Motor: Muscle bulk, power, tone, reflexes and ROM
o	Higher neurological function
•	Visual acuity
18
Q

What MSK examination

A

back and lower extremities

19
Q

What Mx in falls?

A 
Educate patient
Review and modify medications
Vitamin D Calcium
Bone assessment – FRAX/Qfracture → DEXA scan → Bisphosphonate
PT to improve functional mobility, improve gait, strength and balance
Address foot problems
Optimise vision
Optimise home safety

PT:
Strength and balance training
Aerobic exercise

OT:
Home hazards assessment

Medical review:
Optimise comorbidities
Diagnose new medical conditions
Medication review
Manage postural hypotension:
- Adequate hydration and salt intake
- Graded standing
- Compression stockings
- Avoid warm crowded places
Cognitive screening
Bone health assessment
Cataract surgery?
Consequences
Loss of confidence, fear of falling
Serious injury
Fragility fracture
Complications from long lie
20
Q

What is the role of OT?

A

Occupational therapists assess the home environment and evaluate older adults capabilities and deficits in relation to functioning safely within their home.

21
Q

What is the role of PT?

A

Improve gait, strength and balance

Geriatrics and Integrated (11 decks)

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