Falls Flashcards
Multifactorial falls risk assessment
components that aim to identify a person’s risk factors for falling
- falls history
- gait, balance, mobility, strength, muscle weakness
- osteoporosis risk
- fracture risk
- perceived functional ability and fear relating to falling
- visual impairment
- cognitive impairment and neurological exam
- urinary incontinence
- home hazards
- CVS exam and med review
prevention / inteventions
strength and balance training
hazard assessment
vision assessment and referral
medication review with modification/withdrawl
at risk of falls:
Motor problems: gait or balance impairment; muscle weakness[3][5][6][7]
Sensory impairment: peripheral neuropathy, vestibular dysfunction, vision impairment[3][5][8][9][10]
Cognitive or mood impairment: dementia, depression, delirium[6][7]
Orthostatic hypotension[3][5]
Polypharmacy or certain medicines (particularly psychotropic medicines and opioids)[11][12][13]
Impairment of activities of daily living[14]
Environmental hazards (e.g., loose rugs, poor lighting, clutter)[3]
Additional factors such as age or comorbid illnesses.[3]
most common causes of falls
- NEUROPSYCHIATRIC
- visual impairment - blurred vision, loss of peripheral vision, diplopia
- peripheral neuropathy: diabetes, neurodegenerative disease, spinal stenosis
- vestibular dysfunction: BPPV, dizziness, vertigo, imbalance
- gait and balance: lumbar disc disease, peripheral neuropathy, gait disorders
- fear of falling
- cognition/mood- dementia, depression
- seizure- vascular disease, infection, neurodegenerative disorder, malignancy
- subdural haematoma- head trauma
- stroke/TIA
causes of falls:
- neuropsychiatric
- cardiovascular
- musculoskeletal
- toxic/environmental
cardiovascular causes of falls
- syncope- transient LOC due to global cerebral hypo perfusion, tachyarrythmia, bradycardia, vasovagal syncope, exaggerated autonomic response (emotion, valsalvaa)
- orthostatic hypotension
- carotid sinus syndrome (facial shaving)
- post prandial hypotension
MSK causes of falls
- joint buckling, instability, poor mechanical mobility
2. deconditioning
toxic / environmental causes of falls
medications- benzo, antidepressants, alpha blockers, duretics, NSAIDS, sedatives
poly pharmacy
substance abuse- alcohol
environmental hazards- loose rugs, tiles, poor lighting, uneven floors, living alone.
history of falls
- location- where were you (any potential environmental factors)
- activity (fall while standing, walking down steps)
- any injuries? trauma, bruise,, fracture
any LOC
any CVS pain, palpitation, dizzy, vertigo
neurological symptoms- tingling, numbness, change in mental status
exams to do
CVS- RR, murmurs
MSK- range of movement, strength and power
neuro- MSE, tremor, rigidity, co-ordination and cerebellar, Rombergs, Dix-Hallpike
vision- visual acuity, nystagmus
Git- general exam of strength, gait, balance.
bloods: FBC, serum b12, blood glucose, electrolyte, thyroid Xray MRI / brain if head ECG - syncope test vision dn hearing dual energy X-ray osteoporosis screening
differential diagnosis for falls
- stroke / TIA
sudden numbness/weakness in face, arm, leg, unilateral. aphasia, dizzy, unilateral or bilateral vision loss
CT head / MRI (ischaemia/haemorrhage) - TIA ‘’
<1 hour. MRI angiography, carotid ultrasound, echocardiogram, ECG - gait / deconditioning
- poly pharmacy. benzo, antidepresants, beta blockers, digoxin, hypoglycaemia
- home hazards
- visual impairment- snellen, opthalmology, emergency referral
7. peripheral sensory neuropahty Romberg fasting blood glucose serum electrolytes thyroid stimulating hormone FBC serum b12 CT of spine MRI of spine
what are the consequences of falls?
long lie
- rhabdomyolysis
- hypothermia
- burns
major trauma
- limb and rib fractures
- intracranial bleeding
lacerations and bleeding death loss of confidence impaired rehab prolonged hospital stay care home financial cost guilt and anxiety
differentials for falls
- mechanical / explaoined
- medical (syncope, seizure, vertigo, stroke)
- multifactorial (git, instability, joint deformity, postural sway, sedative)
- UTI/TIA
- cluster falls (acute illness)
multifactorial
Brain, anticholinergic & vasoactives Muscular: sarcopenia, deconditioning Deconditioned balance / inactivity Orthostatic hypotension Specific bone / joint disorders Sensory (esp visual) impairment Peripheral neuropathy Spinal cord & disc disorders Dementia, psychological factors Intracranial lesions
medication that increases risk of falls
affects BP:
Antihypertensives, antianginals, Parkinson drugs, tricyclic antidepressants, antipsychotics
affects HR: Beta blockers (eye drops), calcium channel blockers, digoxin
affects myopathy:
Corticosteroids, colchicine, statins, ethanol, interferon
miosis:
Some glaucoma medications, especially pilocarpine
attention and psychomotor:
Benzodiazepines, sedating antihistamines, opioids, tricyclics, SSRIs, antipsychotics, antiepileptics, ethanol
extrapyramidal:
Antipsychotics, metoclopramide, phenothiazines, SSRIs
peripheral:
Nitrofurantoin, phenytoin, amiodarone, hydralazine
