Falls Assessment

Question 1

What are the 7 elements to a falls assessment?

Answer 1

1. Falls history
2. Comorbidities
3. Meds review
4. Physical exam
5. L+S BP
6. TUGT
7. Referral to OT for home assessment

Question 2

Things to ask in a falls history

Answer 2

How
Where
Dizziness on standing - postural hypotension
Blackout - cardiac syncope
Rushing to loo - UTI?
How many
Seizure?
Post prandial? - splanchnic VD

Question 3

Meds review in falls pts

Answer 3

Timing
Dose - could it be reduced?
Consider gradual reduction of antidepressants/psychotics/sedatives
Reduce antihypertensives, alpha blockers. Set individual BP targets

Question 4

Physical exam in a falls assessment

Answer 4

Vision - if Snellen <6/12 refer
Neuro limbs - refer for balance and strength training 
Peripheral sensation 
Knee - OA, fixed flexion
Feet/footwear
Heart rate and rhythm 
Cognition
ECG
FRAX

Question 5

How to do a lying and standing BP

Answer 5

Lay for 5 mins
Stand up
Take BP: immediately, 1min, 3min
= > 20mmHg fall in systolic or > 10 diastolic

Question 6

What are you assessing in a Timed Up and Go Test?

Answer 6

Sitting posture
Ability to stand
Pace
Gait
Turning
Ability to sit

(Walk 3m timed, use usual walking aid)

Question 7

Management of postural hypotension

Answer 7

1. Reduce/withdraw:
   - antihypertensives
   - alpha blockers
   - psychotropics
2. Maintain water (1L before noon, 2L daily) and salt (10g/d) intake
3. If above is inadequate: fludrocortisone OD (retains salt and water)
   - monitor for supine HTN, volume overload, electrolyte abnormalities

Question 8

What are some causes of cardiac syncope?

Answer 8

Bi/trifascicular block 
Prolonged QRS 
2° HB 
Sinus Brady (<50 or pause of ≥3s)
Ventricular ectopics
Non-sustained VT
Long/short QT
Myocardial ischemia