Falls

Question 1

Define a fall?

Answer 1

WHO
Person coming to rest, inadvertently, to the floor or lower level.

A normal person would not fall. Older people have altered physiology so they dont recover and end up falling. Multifactorial (not mechanical!)

Question 2

What is needed not to fall?

Answer 2

Postural stability and sway

- MSK components, vision, proprioception, sensation, higher level control and planning.

Question 3

Intrinsic risk factors for falling?

Answer 3

• Previous falls
• Gender
• Living alone
• Ethnicity (Caucasian more)
• Neurological deficit (stroke, parkinsons, cerebellar disorders, higher level gait disorder, vestibular pathology, myelopathy, peripheral neuropathy)
• Medical co-morbidities (depression, urinary incontinence, arthritis, foot problems, visual defects)
• Low BMI, fear of falling. sedentary behaviour
• Orthostatic hypotension, secondary to drugs or disease. Syncope also, likely to have facial injury.

Question 4

Extrinsic risk factors for falling?

Answer 4

Environmental hazards:

• poor lighting
• slippery floor
• uneven surfaces

Foot wear + clothing
Inappropriate walking

Polypharmacy

Alcohol

Question 5

Complication of falls?

Answer 5

Long lie, greater than 12 hours:

• pressure sores
• dehydration
• hypothermia
• pneumonia
• death

Question 6

Prevention of falls?

Answer 6

Older people must be asked if they have fallen in the past year.

Multifactorial assessment

• doctors
• therapists

Question 7

What happens in a falls clinic / multifactorial assessment?

Answer 7

Hx
Exam
Rating scales
- gait / balance
- osteoporosis (FRAX)
- functional ability (Barthel ADLs)
- cognition (MOCA)
- timed get up and go, walk 3 metres and back in less than 20 secs.

Medication review
Home hazards assessment

Question 8

What specifically can Doctors do to prevent falls / falls clinic?

Answer 8

Medication review
Identify and optimise co-morbidities
Vision
Assessment of syncope - pacemakers
Bone protection
Vitamin D

Question 9

What specifically can Physiotherapist do to prevent falls / falls clinic?

Answer 9

• home hazard modification
• podiatry
• foot wear
• strength and balance
• resistance training

Question 10

Falls in hospital?

Answer 10

Low threshold for imaging, CT head.
Neuro obs
Document it and tell relatives

can be a marker of hospital performance