Falls in older people Flashcards

1
Q

causes of falls

A
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2
Q

what do drugs decrease that causes falls

A

Blood pressure
Heart rate
Awareness

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3
Q

what do drugs increase that causes falls

A

Urine output
Sedation
Hallucinations
qTC
Dizziness

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4
Q

Culprit drugs for falls

A

Antihypertensive
Beta blocker
Sedatives
Anticholingerics
Opioids
Alcohol

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5
Q

where do people that have fallen go

A

Falls clinic
Likely to be well patients, difficult and multifactorial falls
A+E
More likely to be acutely unwell. May not be possible to do it all
Assessing a hospital inpatient who has fallen
Very likely to be acutely unwell. Significant injury possible

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6
Q

The falls clinic is a full MDT including

A

Nurse
Eye test, ECG, Lying and standing BP, incontinence questionarrie. MMSE
Physiotherapist
Full assessment of gait and balance
Doctor
Through history and examination, consider bone health and osteoporosis screening. (45 minutes +)
MDT discussion
Treatment plan made

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7
Q

History in falls

A

PC/HPC Detail of the fall. What were you doing. Who with? What happened? What happened next. How did you get up off the floor

Collapse with no memory ?syncope or cognition
Clear history of trip – think sensory (eyes, nerves)
Palpitations preceding fall and no trip - think cardiac
On turning – think postural instability
Any ‘near misses’- unsteady on standing
Syncope on exertion think aortic stenosis

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8
Q

Systematic enquiry

A

Very important – in addition to usual things
Memory – Ideally ask a relative too
Urinary symptoms (they won’t tell you if you don’t ask)
Has walking changed recently

Drugs
Yes, I want to know everything. Especially over the counter antihistamines…
Especially alcohol

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9
Q

Examination of a fall

A

Get patient on couch
Head and arms
Cranial nerves, apart from smell. Check glasses
Check neglect,
Cerebellar signs
Bradykineasia, ridigidity – signs of PD
Pulse, (BP) Heart sounds. Signs of heart failure and respiratory disease
Kyphosis
Abdominal examination (+PR if prostate)

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10
Q

leg examination following a fall

A

Look at feet (footware, toenails).
Check sensation, vibration sense, and proprioception – remember usually glove and stocking not dermatomal
Co-ordination

Put shoes and socks back on. (You may need a shoehorn)
Stand patient up.

Romberg’s
Assess gait

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11
Q

investigations following a fall

A

ECG
Bloods : FBC, U+E, LFT, Ca++, CRP, PV, B12, folate, folic acid, TFTs.

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12
Q

Do I need to CT a head injury?

A

Yes immediately if:
Low GCS <13
Still confused after 2 hours (or not back to baseline cognitive state)
Focal neurology
Signs of skull fracture
Basal skull fracture – CSF leak, bruising around eyes,
Seizure
Vomiting
Anti-coagualtion

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13
Q

Should I x ray that?

A

If pain on moving a joint have low threshold of x ray

If no deformity but pain on weight bearing have low threshold to x ray
People can walk on fractured hips (I don’t know how either!)

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14
Q

What caused the fall in inpatients

A

All the same things as outpatients and….
Patient getting postural hypotension (or just hypotension) due to illness
Or new medication
Low blood glucose
Or getting sicker
DELIRIUM DELRIUM DERLIRUM
De-conditoning
Call bell out of reach, no appropriate footwear.

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15
Q

Nurses actions post-fall

A

Repeat risk assessment
Datix
Call family
Try and prevent further fall

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16
Q

rules for moving patients

A

if you move it put it back

patient looks unsteady - don’t catch them guide them down

fall prevention care plan

17
Q

what can bisoprolol cause

A

postural hypotension and bradycardia