Falls Flashcards
What causes a fall?
Intrinsic = vision, cognition, CVS, infection, neuropathy, myopathy, surgery, arthritis, seizures, dementia
Extrinsic = medications, incorrect/no walking aids, environment (accommodation, floor covering, lighting, furniture, pets, weather), glasses, footwear, hearing aids, other people, activity at the time, medication
What medications put a pt at increased risk of falls?
Diuretics = BP drop, electrolyte imbalance
Abx = diarrhoea, rush to toilet
Parkinson’s
Anaesthetics = confusions, regional block
Anti-HTN
Anti-histamine
Laxative = diarrhoea
Insulin overdose = low glucose
Gliclazide
Rate limiters = beta blockers
SSRI = postural hypotension
Stains = myopathy, myalgia
Alpha blockers = tamsulosin, vasodilation
Side effect of confusion
Pain relief
Anti-anxiety - diazepam
What questions should be asking when Hx a falls pt?
When, where, witness?
Injury?
Other symptoms - postural dizziness (BP prob), positional dizziness (turned, vestibular problem), palpitations
Previous falls?
Ask about stairs - rails, floor covering
Footwear - examine feet as well
Glasses - near/distance vision, distort visual fields (recommend single vision lenses)
What their normal situation is (holistic view)
Explore any fear
Why presenting to A+E?
How should a fall be investigated?
Examination = CVS, resp, CN, upper/lower limbs, vestibular, abdo, AMTS/CAM, vision, knee exam, feet/footwear, get-up-and-go, home hazards
Bloods = FBC, glucose, U+Es, LFTs, bone profile, TFT, b12/folate, HbA1C, vit D (myopathy)
ECG = arrhythmia, MI
Urine dip = (don’t dip if >65 due to asymptomatic bacteriuria) - MSU
Postural BP (manual sphig) = lay down for 5, stand BP, then stand for 1 and 3 min BP
24hr ECG
ECHO = murmur
CT head = looking for bleed (particularly if on anti-coag)
Bone health + fracture risk assessment = FRAX tool
How should a fall be managed?
Medication review = do they need all meds, are they taking them correctly
Treat a reversible cause
Bone health and fracture risk management
MDT review
Refer to falls clinic if >2/year
Physiotherapy = walking aids, strength and balance training, fall prevention programme
Occupational therapy = environmental adaptations, functional assessments
Postural hypo = fludocortisone
How is orthostatic hypotension treated?
NON-PHARM
- Med reduction/withdrawal = antihypertensive, alpha blockers, antidepressants
- Adequate salt/water intake
- Raise slowly
- Avoid straining, coughing, prolonged standing
- Cross legs while standing
- Raise head of bed 10-20 degrees
- Small meals and coffee in the morning
- Elastic waist high stocking
- Exercise
Fludrocortisone (salt and water retention)
Midodrine
What are the risk factors for osteoporosis?
- Women
- Age
- FH
- Early menopause
- Vit D, calcium def
- Malnutrition
- Smoking
- Low body weight
- Caucasian
***osteoporosis = T-score of -2.5 and below
What medications are used to treat osteoporosis?
Colecalciferol with calcium
Bisphosphonates (alendronate, risedronate, zoledeonate)
Parathyroid hormones
Calcitonin
HRT
Denusomab - for those who are unable to comply with the special instructions for administering alendronate, intolerance or contraindication
Define orthostatic hypertension, the Sx seen and how is it recorded
drop by more than 20mm/Hg in systolic, or 10mm/Hg in diastolic BP
Sx = dizziness, syncope, palpitations
Ix = BP lying down after 1 min, stand up and check BP straight away and again at 3 min, if drop at 3 min then repeat at 4 + 5 min
Mx = fludrocortisone (SE: fluid retention, hypoK)
*** comonly seen in PD
What key areas should be assessed in a falls assessment?
Good Hx + exam
Look for injuries
ECG
Lying and standing BP
Med review
Gait/functional assessment (timed up and go, turn 180 degree test)
Bone health review = FRAX score (if high do DEXA)
- RF = long term steroids, previous fragility fractures, PPIs, low BMI, smoking, RA, tamoxifen, phenotoin, valproate, T1DM
Fear of falling/loss of confidence
Exercise programme
