Falls in older people, balance and gait Flashcards
What sort of history points towards syncope rather than a fall?
Amnesia of the event
lack of premonitory dread immediately before fall
Failure to appreciate impact
What are some adverse outcomes that can result from a fall?
Fear of falling
Rhabdomyalysis and AKI
Social isolation
Injuries and fractures
What is the main risk factor for falls?
Having fallen in the last 12 months
How do beta blockers cause falls?
They cause decreased heart rate and BP which lowers cerebral perfusion
How do nitrates cause falls?
Lower BP and reduce cerebral perfusion
How do benzodiazepines cause falls?
Increase drowsiness
How do diuretics cause falls?
Dehydration, reduce pre load and cardiac output
How do neuroleptics cause falls?
They cause drowsiness
How do steroids cause falls?
Proximal muscle weakness
How do TCAs cause weakness?
Lower BP, cause confusion
How does a hip fracture typicall present?
Shortened, adducted and externally rotated
What are the three major strategies for falls prevention?
Medical review, strength and balance training and environmental assessment
What are the four main aspects of the medical management of falls?
Identifying cause of fall
Optimising management of conditions
Assessing bone health
Medication review to avoid polypharmacy
What investigations should all falls patients have?
ECG and postural BP as standard
Head CT if suspected head injury
What tools can be used to assess the risk of fragility fracture?
FRAX or QFracture
They look at a number of risk factors and calculate risk scores
