Falls

Question 1

What are the 4 types of falls?

Answer 1

• Syncopal
• Non syncopal
• Multifactorial
• Simple

Question 2

Discuss the differences between a syncopal and non-syncopal fall.

Answer 2

Syncope is the mechanism by which cardiovascular abnor-malities may cause falls in older people. The onset of syn-cope is relatively rapid, and the subsequent recovery isspontaneous, complete and usually prompt. The underlying mechanism is a transient global cerebral hypoperfusion.

Question 3

Describe some factors that may predispose patients to fall.

Answer 3

• The fear of falling
• Limitations in mobility and undertaking the activities of daily living.
• Impaired walking patterns (gait)
• Impaired balance.
• Visual impairment.
• Reduced muscle strength.
• Poor reaction times.

Question 4

What medications are particularly important to review in an older person who has fallen?

Answer 4

• Beta-blockers (bradycardia)
• Diabetic medications (hypoglycaemia)
• Antihypertensives (hypotension)
• Benzodiazepines (sedation)
• Antibiotics (intercurrent infection)

Question 5

Name some bedside investigations you would want to carry out in an older person who has fallen?

Answer 5

• Obs
• Lying and standing BP
• ECG
• Urine dip
• Cognitive screening
• Blood glucose

Question 6

Name some blood investigations you would want to carry out in an older person who has fallen?

Answer 6

• FBC
• U&Es
• LFTs
• Bone profile

Question 7

Name some imaging investigations you would want to carry out in an older person who has fallen?

Answer 7

• CXR
• CT head
• Echo

Question 8

Name some specialistic investigations you would want to carry out in an older person who has fallen?

Answer 8

• Tilt table test
• Epley manoeuvre
• 48hr cardiac monitoring

Question 9

Describe the elements of a full falls risk assessment.

Answer 9

• Gait
• Visual Problems
• Hearing difficulties
• Medications review
• Alcohol intake
• Cognitive impairment
• Postural hypotension
• Continence
• Footwear
• Environmental hazards

Question 10

Describe some falls prevention strategies.

Answer 10

• Non slip mats/socks
• Good lighting
• Help for tasks that are too great
• Well fitting shoes
• Taking care of your feet
• Strength and balance training
• Medication review
• Sight test
• Limit alcohol

Question 11

How do you assess bone in the elderly?

Answer 11

The most common approach to assessing bone quality is measurement of bone density, which correlates with bone strength. DXA is the tool of choice in assessing bone density.

Bone mineral density (BMD) measurement is not routinely indicated in healthy young men or premenopausal women. However, it should be considered in those where there is a concern because of their clinical risk factor profile - patients with secondary causes of impaired bone health and those who sustain a fragility fracture.

Question 12

What is a DXA?

Answer 12

A bone density scan uses low dose X-rays to see how dense (or strong) your bones are.