Falls profoma Flashcards
Why are falls more common in the elderly?
- Slower reaction times
- Poor mobility e.g. from OA
- Poor eyesight
- Medical co-morbidity
- Lack of social services
- Inadequate housing/unsafe local environment
Risk factors for falling
- Age over 80 years
- Hx of falls
- Gait or balance abnormality
- Arthritis
- Vision impairment
- Hearing loss
- Use of walking aid
- Cognitive impairment
Differentials- what are some possible causes of falls?
- General muscle loss & weakness
- Acute illness e.g. infection, stroke, heart failure, metabolic disturbance.
- Loss of consciousness
- Ears - vertigo, hearing, labrintitis, ear infection.
- Vision - bifocal glasses, cataracts.
- Postural hypotension - BP drops by more than 20 mmHg
- Dementia or Parkinson’s
- Accidental/environmental causes e.g. slippery floor, rugs, poor fitting shoes.
- Drug & alcohol use
- Cervical spondylosis
- UTI- delirium
- OA of weight-bearing joints
Pathophysiology of falls
See notes on “discuss the cause of falls and why older people are more at risk”
Presentation of falls
- Hx of fall
- Osteoporotic fractures - spine, wrist, hip.
- Bruising
- Loss of consciousness
- Old
- Frail
- Head injury
Investigations for falls
Investigations are based on your HISTORY + EXAMINATION, but could also include some of these:
Blood pressure- hypotension
Imaging:
- Echo- vulvar heart disease
- CT head- chronic or acute subdural, stroke
- Chest x-ray- pneumonia
Bloods:
- U&E- dehydration
- FBC- anaemia, infection (raised white cells)
- liver function test- chronic alcohol use
- Bone profile- calcium abnormalities in malignancy
Urine dipstic- infection, UTI
ECG - bradycardia, arrhythmias
Cognitive screening - cognitive impairment
Blood glucose - hypoglycemia
Management for falls
Falls risk assessment to identify any causes.
Treat underlying medical causes - search for further causes of the fall, even when one has been found.
Rehabilitation:
- Gait & balance- physio
- Visual problems- eye test & glasses
- Hearing difficulties- remove earwax & hearing assessment
- Medications reviews- polypharmacy- reduce unnecessary meds
- footwear- podiatrist assessment
- alcohol intake- cessation
- cognitive impairment- referral to psychiatric team
- Postural hypotension- Review medication , Improve hydration, Sometimes Fludrocortisone
- continence- treat or rule out infections, continence assessment
- Environmental hazards- turn on lights, take up rugs
How can falls be reduced?
- Avoiding drugs w/ sedative effect or cause hypotension.
- Walking aids
- Removal of obstacles in the home e.g. occupational therapy home visits.
- Falls clinics- looks for treatable causes for recurrent falls.
- Bone strengthening- Calcium & vitamin D supplements, Bisphosphonates
- Hip protectors - but they are cumbersome & have poor compliance.
Prognosis for falls
Commonly lead to:
* Soft tissue injury
* Head injury
* Arm and hip fractures
Poor outcomes following a fall:
* Increased mortality
* Long term disability
* Earlier entry into residential care
A patient has fallen over and is taken to A&E, what do you do?
Step 1- take history
-When did you fall?
- Where did you fall?
- What happened before/during and after the fall?
- Why do you think you fell?
- How many times have you fallen over the last 6 months?
Step 2- do systems enquiry
- General = Fatigue, Weight loss
- Cardiovascular = Chest pain, Palpitations
- Respiratory = Shortness of breath, Cough
- Neurological = Loss of consciousness, Seizures, Motor or sensory disturbance
- Genitourinary = Incontinence, Urgency, Dysuria
- GI = Abdominal pain, Diarrhoea, Constipation
- MSK = Joint pain, Muscle weakness
Step 3- past medical history
- General = Visual/hearing impairment, Diabetes, Anaemia
- Cardiovascular = CVD, Arrhythmias
- Respiratory = COPD
- MSK= arthritis, fractures
Step 4- social history
- Alcohol intake
- Support at home – friends/family and carers
- Mobility – use of mobility aids and when (e.g. zimmer frame downstairs only)
Step 5- medications review
- Most medications haveside effectswhich can increase risk of falls.
- Polypharmacy is a risk factor for falls.
- de-prescribe those which are no-longer indicated.
- Benzodiazepines (sedation causes falls)
- Beta-blockers (bradycardia) (causes postural hypotension)
- NSAIDS (cause confusion)
Step 6- clinical examination
- check bp
