Falls Flashcards
What are the intrinsic causes of a fall?
Age History of falls Alcohol Acute illness Gait and balance Polypharmacy Cognitive problems Cardiovascular Postural hypotension Physical deficit Continence problems
What are the extrinsic causes of a fall?
Ground surfaces Furniture Lighting Bathroom Clothing Walking aids
What are the consequences of a ‘long lie’ fall?
Hypothermia Pressure related injury, sores Dehydration and AKI Infection (pneumonia) Rhabdomyolysis
Which fallers needs a 24hour tape or echo?
Diagnostic yield only 2% if ECG normal
Frequency of symptoms means alternatives may be more appropriate e.g implantable loop recorders (36mnths), spider flash (1mnth)
What are the NICE guidelines for interventions after a fall?
Multi-professional assessment
Medical review- medications/bone health assessment
Nurse assessment- eyes, hearing, continence
Therapy assessment- balance and function
Tailored interventions
What are the types of dizziness?
Light headed- cardiovascular (exertion) / OH (postural, situational)
Vertigo- illusion of movement
Disequilibrium- multifactoral/constant imbalance
What are the classifications of orthostatic hypotension?
Classical- low BP 20/10 within 3 mins
Initial OH- low BP >40/20 within 30 sec
Delayed OH- tilt diagnosed
Postural orthostatic tachycardia syndrome- young female, rarely syncope, exaggerated tacky, tilt diagnosis
What are the causes of orthostatic hypotension?
Primary- MSA (multiple system atrophy), Parkinson’s
Secondary- diabetes, CRF, spinal cord injury, B12 deficiency, alcohol, MS GBS tabes dorsalis
Drug induced
Volume depletion- bleeding, D+V, Addison’s
What are the types of reflex syncope?
Vasovagal- simple faint
Situational- cough, defection, micturition, swallow, laugh
Carotid sinus syndrome- CSM diagnosed, cardioinhibitory (>3 sec pause), vasodepressor (lower 50mmHg with symptoms mixed)
Neurocardiogenic- tilt diagnosed, cardioinhibitory, HR <40bpm, >10 sec, vasodepressor (<80 no HR change mixed)
Plan for OH/vasodepressor reflex syncope?
Education/reassurance (warning/prevention)
Conservative management- adequate hydration, compression stockings (orthotics)
Fludrocortisone (50mcg-300mcg)- beware hypokalaemia
Midodrine (2.5mg ids), specialist only- increases total peripheral resistance
How should you counsel someone taking midodrine?
Avoid administration at night
Common side effects: paraesthesia, supine hypertension, urinary disorders, chills, flushing
Hepatic an darnel function testing before and during treatment
What are common abbreviations used by physios?
ROM- range of movement
TUG- timed up and go
TUSS- Timed unsupported steady stand
BBS- berg balance scale
How should you advise patients not he results of their FRAX score?
Low- reassure patient, dietary advise for calcium and regular exercise
Medium- more detailed history of fractures within the family and lifestyle factors, refer for DEXA scan, medication advice if recommending treatment to GP
High- recommend treatment to GP, counselling in dietary, exercise and medication advice
What components does the FRAX score contain?
Previous fracture Parent fractured hip Current smoking Glucocorticosteroids Rheumatoid arthritis Secondary OA Alcohol 3 or more units per day Femoral neck BMD
What are examples of sedative drugs which can contribute to falls?
Benzodiazepines/z-drugs
Tricyclic antidepressants (amitriptyline, trazodone)
Antipsychotics
Barbiturates
Anticonvulsants
Sedating antihistamines (chlorphenamine, hydroxyzine)
Opiates
