Falls in older people

Question 1

What is the total cost of fragility fractures to the UK per year?

Answer 1

£4.4 billion per year

Question 2

Falls in older adults are most likely to result in which type of brain bleed?

Answer 2

Subdural haematoma

Question 3

List 4 psychological impacts of falling.

Answer 3

Fear of further falls - loss of confidence, immobility

Anxiety disorders

Depression - due to reduced independence

Anxiety in carers - may lead to elder abuse

Question 4

Define syncope.

Answer 4

Sudden, transient loss of consciousness due to reduced cerebral perfusion

Question 5

List 6 causes of syncope.

Answer 5

Orthostatic hypotension
Vasovagal response
Carotid sinus syndrome
Cardiac arrhythmia
Outflow obstruction (aortic stenosis)
Pulmonary embolism

Question 6

What 2 times of day do most falls occur?

Answer 6

Afternoon and evening

Question 7

Which acronym can be used to assess risk factors for falls in older adults?

Answer 7

D - drugs
A - age-related changes
M - medical conditions
E - environmental factors

Question 8

Which acronym can be used to assess a patient following a fall to gain better understanding of the circumstances?

Answer 8

S - symptoms
P - previous falls
L - location
A - activity (what doing when fell)
T - time
T - trauma (injuries that need attention)
D - drug history

Question 9

What is the diagnostic criteria for orthostatic hypotension?

Answer 9

A SBP drop of >20 mmHg and/or a DBP drop of >10 mmHg within 3 minutes of standing, with symptoms

Question 10

What is the diagnostic criteria for post-prandial hypotension?

Answer 10

A SBP drop of >20 mmHg within 90 minutes after eating a meal

Question 11

Which type of glasses increase the risk of falling?

Answer 11

Bifocals

Question 12

Which 2 tests can be used to assess patients’ gait and balance following a fall?

Answer 12

Timed Up & Go test

Turn 180o test

Question 13

Describe what is meant by a Timed Up & Go test.

Answer 13

Patient gets up from a chair without using their arms, walks 3 metres, turns around and returns to the chair

Question 14

In a Timed Up & Go test, which value indicates increased risk of falling?

Answer 14

12 - 15 seconds or more

Question 15

In a Turn 180o test, which value indicates increased risk of falling?

Answer 15

> 4 steps

Question 16

Which 3 categories of patients should be offered a multifactorial falls risk assessment?

Answer 16

People aged >65 who:

• have had >2 falls in the last year
• present following a fall
• perform poorly on the Timed Up & Go and/or the Turn 180o test