Falls risk counselling

Question 1

A 74 year old male is admitted to hospital for an exacerbation of COPD, his other problems include obesity, OSA, hypertension, type 2 diabetes and previous myocardial infarction. He is having difficulties mobilising. His son is concerned about him falling. How would you manage this situation?

Answer 1

Impression
Given the significant number of medical comorbidities that this patient suffers from and the recent difficulties with mobilisation, this patient is at a considerable falls risk. There is likely concomitant deconditioning associated with this presentation with multiple CVD comorbidites which place this patient at increased falls risk.

Would want to rule out any acute medical causes of falls:

• Postural hypotension
• CVD: stroke, ACS
• infective

Aims

• Take thorough Hx/Ex/Ix to identify falls risks and implement appropriate mitigation strategies
• counsel patient and son about risks, understand concerns and provide appropriate patient/family education

Question 2

Falls risk counselling – History

Answer 2

History

• Main points: current mobility baseline, use of any aids? previous falls, any injuries sustained? circumstances of the halls, Identify current home environment and risks (steps, rails, paths)
• Identify sons concerns, why specifically concerned about falling?
• patient independent in ADLs or gets help? degree of support, who provides care?
• PMHx and active issues: screen for current medical issues
• meds Hx: assess for polypharmacy, identify meds that increase risks of falls (ACEi, etc)
• SNAP

Question 3

Falls risk counselling – Examination

Answer 3

Examination

• reassess vitals
• Gait and neuro assessment
• cognitive screening
• vision and hearing testing
• postural BP

Question 4

Falls risk counselling – Investigations

Answer 4

Investigations
- nil indicated unless active and unresolved medical condition

Other

• Bedside: BSL, ECG
• Bloods: FBC, UEC, LFT (baselines)
• Imaging: Brain imaging if recent fall and ?trauma

Question 5

Falls risk counselling – Management

Answer 5

Management
Depends on whether inpatient vs outpatient setting

In-patient basis

• patient and son education
• lower bed, falls mat, rails
• supervised attendance to toileting, etc
• medications review and adjustment as per treating team to limit falls risk
• optimise medical treatment for COPD exacerbation (ABx, ICS, etc)

Outpatient

• GP follow-up/review, consider TCA if not already in place
• ACAT referral for ?aged care packaging
• allied health referrals: OT for home mods, physio for rehab and increasing muscular strength (various conditioning programs)
• stepping on program
• other specialist referrals for optimising other medical issues