Falls

Question 1

what percentage of over 65s fall each year?

Answer 1

28-35%

Question 2

What percentage of the over 80s fall at least once a year?

Answer 2

50%

Question 3

What percentage of falls in the elderly result in serious injury?

Answer 3

5%

Question 4

How many who fall initially will go on to have another fall?

Answer 4

66%

Question 5

What are risk factors for falls?

Answer 5

• Previous falls, especially if in last 12 months
• Age >80
• low weight
• dependency on ADLs
• fear of falling
• Balance problems e.g. vertigo ataxia, alcohol problems, ear infection, benign positional vertigo
• Gait and mobility problemse.g. PD, arthritis, previous fractures, MND< joint replacement
• Pain e.g. fractures, arthritis,
  Drugs - anti-hypertensives, sedatives, antipsychotics
• Cardiovascular conditions e.g. arrhythmias, postural hypotension, syncope, MI, PE
• Cognitive impairment e.g. dementia or dementia - forget their walking aid
• urinary incontinence - running to the toilet, especially in the night
• stroke- weakness in limbs caused by previous or acute stroke/TIA
• diabetes - peripheral neuropathy, diabetic foot, hypoglycaemia, diabetic visual impairment
• visual impairment
• environmental - no adequate railings, rugs

Question 6

what is important to ask in a falls history?

Answer 6

• is it an isolated event or one of many?
• if many is there a pattern? how often? common precipitating factor?
• what caused the fall?
• what were they doing the time?
• any loss of consciousness?
• Any warning before the fall? loss balance? feeling dizzy/faint?
• how were they after the fall?
• Can the witness describe?

Question 7

What investigations should you do for falls?

Answer 7

• Bloods (FBC may see macrocytosis if alcohol misuse), LFTs ( abnormal may show alcohol misuse)
• urinalysis - may show unsuspected diabetes
• ECG - AF, conductive defects
• ambulatory ECG - may discover bradycardia periods and heart block
• Echo - assess ventricular or valvular function or detect arterial thrombus
• visual assessment
• neuro imaging if syncope or TIA/Stroke

Question 8

What environmental factors can help prevent falls?

Answer 8

• walking aids
• removal of any loose rugs, mats, electrical leads etc.
• put in fittings and rails
  make sure furniture is in suitable places

Question 9

What can help power and balance in order to prevent falls?

Answer 9

• exercise + physical activity

* physiotherapy

Question 10

What other general things can be done to prevent falls?

Answer 10

• treat underlying disease where possible eg. levodopa for PD, cataract surgery, pacemaker etc.
• occupational therapists
• stop any medication which could predispose falls
• try and reduce Polypharmacy (as is known risk)
• education and information to patient