Falls

Question 1

what are the risks associated with long time on the floor after falling?

Answer 1

hypothermia
dehydration
pressure sores
rhabdomyolysis
venous thromboembolism
bronchopneumonia
muscular deo-conditioning

Question 2

who are falls most common in?

Answer 2

women
residents of long term care
unwell patients in hospital
cognitive impairment

Question 3

why are falls common in elderly and cognitively impaired?

Answer 3

becomes quite complicated and difficult to stay upright so any distraction or knock can cause a fall

Question 4

physiological causes of falls due to ageing?

Answer 4

vision reduced - smaller pupils, thickened lens causing reduced light
reduced reaction time
lower cardiorespiratory fitness
sarcopenia (loss of muscle mass and function)
reduced peripheral sensation and proprioception
increased postural sway

Question 5

common age related pathology related to falls?

Answer 5

often multiple chronic conditions
cardio disease
neurological
vestibular
visual
MSK

Question 6

how common is syncope as a cause for falls?

Answer 6

20% be suspicious if significant head/facial injuries

Question 7

common causes of syncope in elderly?

Answer 7

arrhythmias
orthostatic hypotension
neurogenic (vasovagal)
carotid sinus hyperactivity
valvular heart disease (aortic stenosis)

Question 8

what is orthostatic hypotension?

Answer 8

rapid drop in BP after standing up quickly

causes dizziness/light headedness etc

Question 9

what is the highest incidence of falls and why?

Answer 9

cognitive impairment
impairs
- judgement
- visual-spatial perception
- orientation

Question 10

what assessment must always be done after a fall?

Answer 10

neurological

Question 11

what neurological disorders commonly cause a fall?

Answer 11

cervical myelopathy
- high stepping gait, rombergs positive
peripheral neuropathy
- altered sensation and wide based gait
lumbar stenosis
- pain/paraesthesia in legs, wide based gait
cerebellar ataxia
- wide based gait, cerebellar signs
parkinsons disease
- shuffling gait, tremout/rigidity/bradykinesia, orthostatic hypotension
stroke disease

Question 12

what is vestibular disease?

Answer 12

causes vertigo and imbalance

e.g BPPV

Question 13

which types of lens in glasses can increase the risk of falls?

Answer 13

bifocal/varifocal lenses as they alter depth perception

Question 14

extrinsic risk factors for falls?

Answer 14

medication
alcohol
hazards (rugs, clutter, lighting etc)
clothing/footwear
inappropriate walking aids

Question 15

give examples of drugs which increase risk of falls?

Answer 15

benzodiazepines
neuroleptics
antihypertensives
antidepressants
anticholinergics
class 1A antiarrhythmics
polypharmacy >4 = independent risk factor

Question 16

routine falls screening?

Answer 16

have you had 2 or more falls in past 12 months
have you presented acutely with a fall?
do you have problems with walking or balance?

Question 17

full falls history?

Answer 17

what happened before and after
impact/consequence of fall
witness account
accurate medication list

Question 18

clinical examination after fall?

Answer 18

ABCDE
neurological
gait, balance, joints
feet and footwear
CVS
vision
incontinence assessment

Question 19

how is BP tested after a fall?

Answer 19

1: taken after lying flat for 5 mins
2: taken after standing in first min
3: taken after standing for 3 mins
record symptoms of dizziness, light-headedness, vagueness, pallor, vision etc

Question 20

what assessment tools are useful after a fall?

Answer 20

timed up and go test (TUG)
berg balance scale
tinetti score

Question 21

what interventions can help prevent future falls?

Answer 21

strength and balance training (3X a week for 12 weeks)
environmental modifications
footwear and foot care
vision optimization
patient education and treatment
medication review
manage BP and arrhythmias

Question 22

what is the tinetti score?

Answer 22

score of gait and balance