Immobility and Falls Flashcards
What are some potential causes of falls in the elderly?
- Musculoskeletal- Arthritis, sarcopenia, deformities of feet
- Drugs- anti-hypertensives, sedatives, alcohol
- Neurological- stroke, Parkinson’s, dementia, delirium, ataxia
- Sensory- visual impairment, inattention
- Cardiovascular- postural hypotension, arrythmia, heart failure, aortic stenosis
- Incontinence
Through what mechanisms can medications cause falls?
Medications can cause falls by decreasing blood pressure, heart rate or awareness or by increasing urine output, sedation, dizziness or hallucinations
What drugs commonly cause falls?
- Antihypertensives
- Beta blockers
- Sedatives
- Anticholingerics
- Opioids
- Alcohol
What specific enquiries should be made in a falls history?
Cognition changes
Urinary symptoms
Drugs- especially alcohol and OTC antihistamines
What steps should be taken in a falls examination?
- Cranial nerves excluding smell
- Check neglect
- Check cerebellar signs
- Check for bradykinesia or rigidity
- Pulse, blood pressure and heart sounds
- Kyphosis
- Abdominal examination
- Full neuro examination of legs and feet
- Romberg’s test
- Assessment of gait
What pathology causes an ataxic gait?
Cerebellar damage
What pathology causes an arthralgic gait?
Arthritis
What pathology causes a hemiplegic gait?
Stroke
What pathology causes a small stepped/shuffling gait?
Vascular parkinsonism
What pathology causes a high stepping gait?
Peripheral neuropathy
What extra checks should be made if a patient has had a long lie following a fall?
Creatinine kinase blood test to check for rhabdomyolysis
Pneumonia and skin injuries more common
What steps should be taken during a falls assessment in A&E?
- Blood tests- B12, folate, CK, TFTs
- Neurological examination plus chest and abdomen
- Look at legs and assess gait if possible
- Thorough history and ambulance sheet
- Full set of obs
- ECG for every fall
- Check for delirium using 4AT
- Consider CT head if fall with head injuries or neurological signs or anticoagulation
What injuries should be checked for following an in-patient fall?
- Head injury and extra dural
- Seizure
- C spine injury
- Flail chest
- Abdominal injury
- Pelvic injury
- Limb fracture
What characteristics would indicate need for an immediate head CT?
- GCS <13
- Still confused after 2 hours (or not back to baseline cognitive state)
- Focal neurology
- Signs of skull fracture
- Basal skull fracture – CSF leak, bruising around eyes,
- Seizure
- Vomiting
- Anti-coagualtion
What are the indications for limb x-ray following a fall?
Pain when moving a joint. It is possible for people to walk on fractured hips so a low threshold should be kept when pain is present in a weight-bearing limb.
