Falls

Question 1

List some complications of falls in the elderly

Answer 1

Fractures 
Pneumonia 
Rhabdomyolysis 
Dehydration 
Urinary incontinence 
Confusion 
Pressure sores 
Venothromboembolic events

Question 2

List medical causes of falls

Answer 2

CVS/syncope 
Cognitive impairment 
Neurological 
Vestibular impairment 
Vision 
MSK/gait

Question 3

List extrinsic causes of falls

Answer 3

Medications
Environmental
Alcohol
Footwear

Question 4

Give CVS reasons for falls

Answer 4

Arrhythmias
Postural hypotension
Carotid sinus hypersensitivity
Valvular disease

Question 5

How do you diagnose postural hypotension

Answer 5

Lie flat for 5 minutes and take first BP reading
Stand up and measure BP in first minute
Measure BP again after standing for 3 minutes
Also record symptoms
Fall in SBP >20mmHg or DBP >10mmHg after 3 min standing

Question 6

What are the consequences of cognitive impairment

Answer 6

Impaired judgement, visual spacial awareness, orientation

Question 7

Give neurological causes for falls

Answer 7

Cervical myelopathy 
Peripheral neuropathy 
Lumbar stenosis 
Parkinsons 
Stroke 
Cerebral ataxia

Question 8

Give vestibular causes for falls

Answer 8

BPPV

Question 9

Give visual reasons for falls

Answer 9

Cataracts
Visual field defects
Varifocal lenses

Question 10

Give MSK reasons for falls

Answer 10

Stroke
Parkinsons,
Arthritis
Sarcopaenia

Question 11

List drugs that can lead to falls

Answer 11

Benzodiazepines 
Neuroleptics 
Anti-cholinergics 
Anti-hypertensives 
Anti-depressants 
Anti-arrhythmics

Question 12

What is the usual cause for a fall

Answer 12

MULTIFACTORIAL

Question 13

How do you manage falls

Answer 13

Review medications - anti-hypertensives, sleeping pills...
ECG - arrhythmias 
Neuro exam 
DEXA scan for osteoporosis 
Snellen chart 
Strength and balance training x3week for 12 weeks 
Environmental modification
STOPP/START