Falls Flashcards
what is the cause of falls in the elderly
multifactorial
list risk factors for falls
female age >80 peripheral neuropathy muscle weakness - sarcopaenia poor gait polypharmacy any psychotropic medications previous fall visual impairment cognitive impairment urinary frequency, UTI constipation acute illness / infection anaemia Neuro - PD, MS, MND, stroke, peripheral neuropathy, seizures, cervical myelopathy diabetes, thyroid
list complications of falls
fractures dehydration pressure sores AKI - rhabdomyolysis delirium malnutrition pneumonia hypothermia VTE
what body systems can cause falls
pretty much all of them (except obstetrics!)
list CVS causes of falls
postural hypotension syncope / vasovagal carotid sinus hypersensitivity arrhythmias valvular disease
list causes of postural hypotension
medications anaemia dehydration sepsis alcohol carotid sinus disease autonomic failure - PD, DM adrenal insufficiency
list drug causes of postural hypotension
nitrates ACEI diuretics levodopa anticholinergics antiplatelets SSRIs
list neurological causes of falls
cervical myelopathy lumbar stenosis peripheral neuropathy stroke MS MND Parkinsons delirium
List MSK causes of falls
arthritis imbalance / poor gait post stroke myopathy sarcopaenia
list visual causes of falls
ARMD
cataracts
list vestibular causes of falls
BPPV, menieres, labyrinthitis
list extrinsic causes of falls
alcohol
footwear
environmental
living alone
list drug causes of falls (ie not those that cause postural hypotension)
benzodiazepines opiates antipsychotics antiarrhythmics codeine anticonvulsants
list examinations and investigations for falls
CVS - murmurs, bruits hydration status LSBP ECG, ECHO Neuro exam MSK exam Visual assessment Vestibular assessment cognitive exam footwear assessment
list investigations for falls
FBC, U+E, LFT, TFT, bone group, B12, glucose drug review Get up and go test FRAX + DEXA Imaging
Management of falls
identify and reduce risk factors drug review - STOPP PT / OT bone protection fitness to drive
what are important things to ask in a falls history
HPC - mechanism of fall, witnesses, LOC, injuries, visual disturbance, memory, dizziness, prodromal, toilet
PMH
DH
SH
What is an R test
24 hour ECG trace
what additional test should you ask for if the patient has had a long lie after a fall
CK
Contraindications to bisphosphonates
renal disease
