Falls

Question 1

Factors that increases one’s risk of falling

Answer 1

Intrinsic to patient:

• Muscle strength
• Stable joints
• Sensory modalities: proprioception, vision, eye sight
• Functional CNS and PNS

Extrinsic:
- Environmental: light, obstacles, wind, grip of floor, supporting rails.

Question 2

Factors that increases the severity of a fall

Answer 2

Osteoporosis
- More likely to fracture

System impairments:
Fewer saving mechanism (i.e bleeding)
- Secondary injury post fall, especially if left on the floor too long): dehydration, pneumonia
- Psychological effects

Question 3

History for falls- HPC structure

Answer 3

Broken down into
- Before
- During
- After
fall

Question 4

HPC fall- Before

Answer 4

How they were feeling on the day of the fall.

Where they were: at home, with anyone?, weather?
What they were doing.

Any warning symptoms before fall:

• Chest pain
• SOB
• Lightheaded/ dizziness
• Headache
• Aura/ blurred vision
• Nausea, abdo pain
• Weakness in legs

Question 5

Fall HPC- during fall

Answer 5

Why they fell?

• Trip/ slip?
• Loss of consciousness

How they fell

• Body parts hitting the ground, areas affected
• Hit head?

Anyone witness the fall?

Incontinence/ biting of tongue

Question 6

Fall HPC- after fall

Answer 6

Memory of the fall?

If they were able to get up?

How long they were on the floor?

Any help to get up?

Any new symptoms after fall:

• Pain in joint/ limb
• Weakness in limbs/ face
• Speech
• Balance affected?
• Cognition
• Vision

Question 7

History- PMH

Answer 7

Cardiac
- Things that can cause syncope: valvular disease, arrhythmia, orthostatic hypotension, previous MI.

Resp

• COPD
• Previous PE?

Neuro

• Epilepsy
• Previous stroke?
• Peripheral neuropathy
• Parkinson’s
• Dementia

MSK

• Arthritis
• Previous fractures

General

• Diabetes
• Anaemia
• Visual/ hearing impairment

Question 8

History- DH

Answer 8

Antihypertensives

• Beta-blockers: bisoprolol, atenolol
• ACEi: ramipril
• ARB: lorsatan
• Diuretics: furosemide, bumetinide
• Alpha blockers: doxazosin
• Ca2+ blocker: amlodipine

Anticonvulsants:

• Gabapentin
• Phenytoin

Sedatives:
- Benzos: diazepam, lorazapam

Hypoglycaemics:
- Sulphonylurea: gliceride

Anti-psychotics:
- Haloperidol

Opiates

Allergies

Question 9

History- SH

Answer 9

Living arrangements

• Live alone?
• What type of building
• Any additional rails?
• Far away from members/ support?

Mobility

• Any aids: frames, walking stick, wheelchair
• Walking up and down steps?

Alcohol, smoking, drugs

Dependency

• Fine getting dressed?
• Cooking meals
• Using the toilet?

Eating?
- Can suggest nutritional deficiencies

Question 10

History- FH

Answer 10

Cardiac problems
- MIs at young age

Cancers

Stroke

Epilepsy

MSK: arthritis

Question 11

Examination structure

Answer 11

General

CVS

RESP

Gastro

Neuro

MSK

Question 12

History- SR

Answer 12

General:

• Fatigue
• Weight loss

CVS

• Chest pain
• Palpitations
• Dizziness/ lightheaded

RESP

• SOB
• Chest pain
• Cough

Neuro

• Weakness
• LOC
• Headache
• Vision/ hearing/ sensation changes
• Balance/ vertigo

GI

• Abdo pain
• Nausea
• Bowels

GU

• Dysuria
• Increased urinary frequency
• Urinary retention
• Incontinence

MSK

• Joint pain
• Back pain
• Muscle weakness

Question 13

Examination- General

Answer 13

Looks well?

• Pale, clammy
• Sweating?
• SOB
• Jaundice, cyanotic

Question 14

Examination- CVS

Answer 14

Pulse

• Arrhythmia
• Bardycardia

BP

• Hypotension
• Check lying and standing BP

Auscultation
- Murmurs

Conjuctival pallor
- Anaemia

Carotids
- Bruit

Question 15

Examination- Resp

Answer 15

Cyanosis?

Raised JVP?

SOB? Increased RR

Auscultation: crackles, wheeze, air entry

Percussion
- Dullness/ hyper-resonance

Question 16

Examination- Abdo

Answer 16

Palpation

• Tenderness
• Rigid?
• Organomegaly

Question 17

Examination- Neuro

Answer 17

CN

• Visual acuity
• Eye movement
• Facial/ shoulder weakness
• Altered sensation: smell, hearing, taste, feeling

Neuro

• Tone
• Power
• Co-ordination
• Reflexes
• Sensation

Question 18

Examination- MSK

Answer 18

GALS

• Gait
• Joint movement

Get up and go test

Signs of injury/ fracture

Question 19

Investigations

Answer 19

Bloods
ECG
X-ray of affect limb
Chest X ray
CT head
ECho (murmur)
Cognition: AMSE, MMSE
Head-up tilt table testing
- Unexplained syncope

Question 20

Blood investigations (7)

Answer 20

FBC

• Anaemia
• Infection

CRP

• Infection
• Fracture

LFT

• ALP increased in fracture
• Liver failure/ Alcohol abuse

U+Es

• Electrolyte imbalance
• Dehydration
• Rhabdomyolosis
• Ca2+, B12, Folate, phosphate

Troponin
- MI

Glucose

Bone profile

Question 21

Imaging investigation

Answer 21

Chest X-ray

• Pneumonia
• Fractures

Head CT

• History of head trauma
• Rule out stroke

Echo
- If murmur is heard

Question 22

Factors to reduce fall frequency

Answer 22

Drug review

Treat orthostatic hypotension

Physiotherapy

Occupational therapist

Vision correction

Reducing stressors

Question 23

Factors to prevent adverse effects of fall

Answer 23

Screen and treat osteoporosis

Alarms

Supervision

Treat infection/ dehydration/ delirium

Occupational therapist