Falls Flashcards
What is a simple fall vs collapse§?
Simple fall:
Result of chronic impairment of cognition, vision, balance or mobility
Collapse:
Result of an acute medical problem such as TIA, arrhythmia, vertigo
What should you ask about in falls history?
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
What should you ask about before a fall?
- Any warning
- Any dizziness,
- Any chest pain
- Any palpitations
What should you ask about during a fall?
- Incontinence, tongue biting → seizure
- Loss of consciousness
- Pale/flushed → Vasovagal
- Any injury/pain?
- What part of body made contact first
- Head hit?
What should you ask about after a fall?
- 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)
What factors in systems review?
• 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
What factors in PMHx?
• 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
What factors in DHx?
- Beta-blockers (bradycardia)
- Sulfonylureas (hypoglycaemia)
- Antihypertensives (hypotension) – ACEi, CCB, Diuretics, beta-blocekrs
- Benzodiazepines (sedation)
- Antibiotics (infection)
- PD medication
- Tricyclic antidepressants
What factors in SHx?
- Alcohol intake
- Smoking
- Support at home
- Mobility
- Occupation
What are causes of falls?
Syncopal: CNMV Cardio Neuro Metabolic Vaso
Non-Syncopal Mobility Vision Metabolic Balance Hazards Cognitive
What are intrinsic risk factors for falls?
• 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:
What drugs can cause falls?
o Benzodiazepines o Sedative hypnotics o Anti-depressants o Anti-hypertensives o Anti-arrhythmics o Diuretics o Anti-convulsants o NSAIDs
What are extrinsic risk factors for falls?
• 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
What examination in falls?
General
MSK
CVS
Neuro
What general examination?
• AVPU • Confusion • Time up and go test – within 14s? • Turn 180 test Feet footwear Use of mobility aids
