Falls and blackouts

Question 1

How common are falls?

Answer 1

1/3 of people over 65 and 50% of people over 85 fall each year – the leading cause of accident related death
10% lead to serious injury – 1% to hip fracture
5-10% of AnE visits and 6% of urgent hospitalisation

Question 2

Requirements for standing

Answer 2

musculoskeletal system, proprioception, vestibular organs, eyes, nervous system and sufficient energy

Question 3

Changes with ageing

Answer 3

Less muscle strength and less proprioception
Increased sway when standing or walking
Decreased vision. Joint pain and disease. Poorer cognition

Question 4

Causes of falls

Answer 4

Accidents
Trips
Syncope (cardiac or neurogenic)
Drop attacks – epilepsy etc

Question 5

Contributing factors to falls

Answer 5

17% CVS, 60% visual impairment or poor stereoscopic vision, 35% cataract, 30% leg problems, 20% peripheral neuropathy, 70% balance problems, 35% cognitive impairment, 20% possible depression

Question 6

Risks for falls

Answer 6

CHD or Circulatory disease -- 6.2%
COPD -- 8%
Depression -- 9.4%
Arthritis -- 17.4%
Chronic disease -- 32%

Question 7

Features indicating syncope

Answer 7

Sudden, unpleasant sensory stimulus, Prolonged standing or crowding in warm places, N&V associated with syncope, 1hr post prandial, after extertion, With throat or facial pain, after pressure on the carotid sinus

Question 8

Features indicating seizure

Answer 8

Biting tongue, abnormal behaviour or post-itctal confusion, brought on by emotional stress, head turning to one side during LOC, prodromal deja vu or jamais vu

Question 9

Causes of Dizziness

Answer 9

Vestibular – central, peripheral or BPPV. Acute labyrinthitis
Uncompensated previous vestibular injury. Proprioceptive loss
Central vestibular or cerebrovascular accident. CVS causes

Question 10

Management of falls

Answer 10

Treat medical illness and injury – address precipitant and risk factor
Balance and strength training and OT support
Fracture prevention strategies
Training to get up or call for help

Question 11

Drug causes of postural hypotension

Answer 11

Levodopa
Diuretics
Vasodilators
Alcohol
Treat with Fludrocortisone (can add midodrine)