Falls History Flashcards
Outline the structure of a history of presenting complaint for patients who have fallen
WHO
WHAT
WHEN
WHERE
WHY
HOW
WHO
- Did anyone witness the fall?
WHAT
BEFORE
- Did anything happen/was there a warning beforehand?
- Any dizziness?
- Any palpitations?
DURING
- Incontinence or tongue biting? (seizure activity)
- Loss of consciousness?
- Pale or flushes? –> vasovagal attack
- Did the patient hit their head?
- Which part of their body had first contact with the ground?
AFTER
- What happened after the fall?
- Was the patient able to get off the floor?
- How long did it take?
- How long were they on the floor for?
- Were they able to resume normal activities?
- Confusion after the event? (head injury)
- Weakness or speech difficulty? (stroke / TIA)
WHEN
What time of the day did they fall?
What were they doing?
- Looking up (vertebrobasilar insufficiency)
- Getting up (postural hypotension)
WHERE
Did they fall at home or outdoors?
WHY?
Why do they think they fell?
e.g. tripped over a rug
HOW?
How many times have you fallen in the last 6 months?
Can assess severity
Perform a systems review relevant to the falls history
PSYCHIATRIC: mood
NEUROLOGICAL: loss of consciousness, seizures, motor or sensory disturbance
CARDIOVASCULAR: chest pain or palpitations
RESPIRATORY: shortness of breath or cough
GENITOURINARY: incontinence, dysuria, urgency
GASTROINTESTINAL: abdominal pain, diarrhoea, cramps
MSK: joint pain or weakness
Perform a PMHx inquiry relevant to the falls history
PSYCHIATRIC: depression
NEUROLOGICAL: TIA, stroke, dementia, Parkinson’s, peripheral neuropathy
CARDIOVASCULAR: arrhythmia, CVD
RESPIRATORY: COPD
GENITOURINARY: UTI, incontinence
GASTROINTESTINAL: diverticular disease, chronic diarrhoea, alcoholic liver disease
MSK: chronic pain, arthritis, fractures
Social history relevant to falls history
- Alcohol intake
- Support at home (family, friends)
- Mobility aids
Name 5 medications that increase fall risk, and why
- Beta-blockers (bradycardia)
- Diabetic medications (hypoglycaemia)
- Antihypertensives (hypotension)
- Diuretics (dehydration / hypotension)
- Benzodiazapenes (sedation)
- Antidepressants (sedation)
What would you be looking for in the GENERAL INSPECTION of a patient who has fallen?
Alert and oriented?
‘Get up and go’ test: Ask the patient to get up from the chair/bed and walk three metres then turn around and sit down again. The patient should be permitted to use their walking aid.
- Helps evaluate deficits and functional capacity
- Directs more targeted intervention
What would you be looking for in the CVD EXAM of a patient who has fallen?
Pulse: may have irregularities such as AF or bradycardia
Blood pressure – hypotension
Bruits over carotid arteries (e.g. aortic stenosis, carotid stenosis)
Murmurs: aortic stenosis/regurgitation, mitral stenosis
What would you be looking for in the RESPIRATORY EXAM of a patient who has fallen?
Inspection: increased work of breathing
Auscultation: coarse crackles (e.g. pneumonia)
Percussion: dullness (e.g. pleural effusion)
What would you be looking for in the NEUROLOGICAL EXAM of a patient who has fallen?
Cranial nerve examination: stroke or visual impairment
Power: weakness (e.g. stroke, disuse atrophy)
Tone: increased in stroke
Reflexes: absent (e.g. diabetic neuropathy), hyperreflexia (e.g. upper motor neuron pathology)
Sensation: may be reduced secondary to upper or lower motor neuron pathology
Co-ordination: may be impaired (e.g. chronic alcohol misuse leading to cerebellar degeneration)
What would you be looking for in the GASTROINTESTINAL EXAM of a patient who has fallen?
Organomegaly
Tenderness
What would you be looking for in the MSK EXAM of a patient who has fallen?
Tenderness or bruising where they’ve fallen
What are 5 useful bedside investigations for the assessment of falls?
ECG: cardiac precipitants of the fall
Supine & standing BP: orthostatic hypotension
Urine dipstick: hyperglycaemia, UTI, rhabdo
Cognitive screening: FAB, MMSE, 4AT
BGL: hyper or hypoglycaemia
Which bloods should be ordered, and why?
CBE: anaemia, infection
EUC: dehydration, rhabdo, electrolyte abnormalitieis
LFTs: chronic alcohol use
Bone profile: calcium abnormalities in malignancy, over-supplementation
Which imaging tests should be ordered, and why?
CXR: pneumonia
AP PELVIS and LATERAL HIP: if FNOF suspected
CT HEAD: stroke
ECHO: valvular HD
