Geriatrics - falls + immobility

Question 1

• Outline the main conditions causing immobility and falls and the clinical approach to assessment in the following circumstances

• The hospital inpatient who has fallen
• The patient presenting to hospital after a fall causing injury
• The hospital inpatient who is immobile
• The patient presenting to GP or outpatients who has fallen but not sustained an injury
• The patient presenting to GP or outpatient with a decline in mobility.

Answer 1

.

Question 2

Categorical causes of falls (LEARN) (6)

Answer 2

MSK disease
Drugs 
Neurological
Sensory
Cardiovascular
Incontinence

Question 3

What MSK diseases predispose to falls

Answer 3

OA
Sarcopenia
Deformities

Question 4

What drugs predispose to falls (6)

Answer 4

Antihypertensives
Beta blockers
Sedatives
Anticholinergics - tricyclic antidepressants
Opioids
Alcohol

Question 5

What neurological diseases predispose to falls (5)

Answer 5

Stroke/ TIA
Parkinson's disease/ Parkinsonism 
Dementia
Delirium
Seizure

Question 6

What sensory problems predispose to falls (2)

Answer 6

Visual/hearing impairment

Inattention

Question 7

What cardiovascular diseases predispose to falls (4)

Answer 7

Postural hypotension
Arrythmia
Heart failure
Aortic Stenosis

Question 8

What key questions to ask in the PC/HPC of a fall (5)

Answer 8

What were you doing?
Who with? 
What happened? 
What happened next? 
How did you get up off the floor?

Question 9

A fall due to syncope on exertion is likely due to

Answer 9

aortic stenosis

Question 10

What questions to ask in systematic enquiry of someone presenting with a fall

Answer 10

Memory
Urinary symptoms
Has walking changed recently (can also ask the 3 MSK questions)

Question 11

Examination of someone presenting with a fall should be top to toe

What things are examined for?

• neuro
• cardio
• resp
• abdo

Answer 11

Neuro

• Cranial nerve function
• Any neglect
• Cerebellar signs - ‘DANISH’
• Bradykinesia, rigidity - PD
• co-ordination, sensation, vibration, proprioception
• toes + soles

Cardio

• pulse
• heart sounds
• signs of heart failure

Resp
-lung sounds

MSK

• kyphosis/spinal deformity
• gait (last)

Abdo
-general

Question 12

How is a fall assessed in A&E

• initial
• history

Answer 12

ABCDE, then assess and treat any injury

History (+ look at ambulance sheet)

• how did they fall
• any previous falls
• any cognitive impairment
• any incontinence
• any syncope
• any seizure features
• any alcohol intake
• talk to relative

Question 13

How is a fall assessed in A&E

-investigations

Answer 13

ECG
Bloods - glucose, B12, folate, CK, TFTs
4AT
Maybe CT head if head injury

Question 14

What reversible cause of falls can be corrected quickly

Answer 14

Drugs

Question 15

Assessing a fallen patient consists of 3 stages

Answer 15

ABCDE
History + examination (top to toe)
Investigations - esp glucose

Question 16

Initial approach to an inpatient who has fallen on a ward (2)

Answer 16

Immediately assess for serious injury

Consider cause of fall

Question 17

What ‘serious injuries’ are included in immediate assessment of a fall (7)

Answer 17

Head injury - e.g. haemorrhage
Seizure
C-spine injury
Flail chest
Abdo injury
Pelvic injury - e.g. broken hip
Limb fracture

Question 18

CT a head injury if (7)

Answer 18

Low GCS <13 
Still confused after 2 hours 
Focal neurology
Signs of skull fracture 
Seizure 
Vomiting 
Anti-coagulation

Question 19

Causes of falls in inpatients (same as outpatients + (5) )

Answer 19

Hypotension
New medication
Low BG
Health decline
DELIRIUM 
Call bell out of reach

Question 20

Ways to prevent at risk patients from falling in the hospital (4)

Answer 20

Bed rails
Regular obs
Inform staff so they’re more wary
Ensure aids are within reach

Question 21

How many bisoprolol cause a fall

Answer 21

Postural hypotension