Falls Flashcards
How common are falls in the elderly?
35% of over 65yo and 50% of over 80yo fall at least once a year
10% of falls result in fracture
What things would you ask about in a history of falls?
Before the fall - what were they doing? prodrome?
During the fall - consciousness? fitting? how long down for? incontinence? tongue biting?
After the fall - able to get up? Injuries? post fall symptoms?
Timing - when? how often? more frequent?
How would you systematically split up causes of falls?
General Cardiovascular Resp Neuro Urinary MSK Senses Social
What symptoms may make you think of a general cause of falls and what investigations could you request?
Fatigue
Weight loss
FBC - anaemia
BM - hypoglycaemia
What symptoms may make you think of a cardiovascular cause of falls and what investigations could you request?
Chest pain
Palpitations
ECG
Lying-standing BP
What symptoms may make you think of a respiratory cause of falls and what investigations could you request?
Infection
SOB
CXR
What symptoms may make you think of a neurological cause of falls and what investigations could you request?
Stroke symptoms
Seizures
Peripheral neuropathy
MRI head, CT head
Cognitive assessment
Gait assessment
What symptoms may make you think of a urinary cause of falls and what investigations could you request?
Urgency
Infection
Urine dip
What symptoms may make you think of a musculoskeletal cause of falls?
Muscle weakness
Pain
What symptoms may make you think of a sensory cause of falls and what investigations could you request?
Vision impairment
Visual fields assessment
What symptoms may make you think of a social cause of falls and what investigations could you request?
Alcohol misuse
Environmental
Tox screen
LFT
Social care assessment of living conditions
What mobility/function assessments can be done for elderly patients who are falling?
Timed up and go test
Turn 180 test
Lying standing BP
What happens in the timed up and go test?
Rise for chair without using arms
Walk 3m
Turn and sit down again
Shouldn’t be any unsteadiness or difficulty
What happens in the turn 180 test?
Ask to turn around 180 on the spot
If take more than 4 steps then further assessment is indicated
What negative cycle may elderly people get into following a fall?
Increased fear of falling –> inactivity –> muscle weakness –> increase risk of falling –> fall –> increase fear of falling
What interventions may be considered for falls in the elderly?
Home assessment and alterations
Exercises - Tai-chi
Group classes - involve exercise, break fear of falling cycle
Diagnosis and manage underlying conditions
Medication review
What medications should be reviewed in elderly patients that are falling?
Beta-blockers - bradycardia Diabetic meds - hypoglycaemia Anti-hypertensives - hypotension Benzodiazepines - sedation Antidepressants/antipsychotics NSAID's Antibiotics - intercurrent infection Herbal medication
What makes up a falls risk assessment?
History and examination Drug review Specific symptoms review Mobility assessment Functional assessment Psychological effects of fall
What are some risk factors for falls?
>80 Polypharmacy Frail Alcohol Female Environmental hazards Previous Hx Hypotension Non-independent Cognitive impairment Visual/balance disorder
How is bone health assessed in patients at risk of falling?
FRAX
Qfracture
DEXA scan
What is the FRAX? How would you manage patients based on this?
Estimate 10 year risk of fragility fracture - look at age, gender weight etc.
Low risk - reassure and lifestyle advice
Intermediate risk - DEXA scan
High risk - Bone protection treatment
>10% = high risk, around this is intermediate. Scan based on guidelines and clinical judgement
What is the Q fracture tool?
Risk assessment tool
Take into account wider variety of risk factors than FRAX
What is a DEXA scan (BMD test)?
Look at hip and lumbar spine for mineral density
T score - in relation to young fit adults of same gender who have peak bone mineral density. Normal >-1
Z score - in relation to others of same age, gender and weight
Offer treatment if T
What bone protection treatment can be offered?
Alendronic acid - take in morning, 30 mins before food, sitting upright with 240ml of water
Calcium/vitD supplementation if deficiencies
Zoledronic acid - annual injection (alternative)
