Managing Falls

Question 1

Why are falls important?

Answer 1

Falls make up a huge amount of A&E attendances

30% of one 65s and 50% of over 80s fall at least one a year, some several times a week.

Falls are a abuse of reduced quality of life, loss of confidence and independence and ultimately mortality.

Question 2

What things are important to find out from a history taken regarding the fall?

Answer 2

Who? - anyone else there

When? - time of day, what doing

Where? - House (room)? Shops?

What? - before (symptoms before, chest pain, trip/slip), during (loss of consciousness, incontinence, younger biting, injuries), after (regain consciousness quickly, get up without help, confusion or neurological symptoms)

How? -long on the floor, fallen before, serious injuries

Question 3

What is the most important thing to work out when taking a falls history?

Answer 3

Did they loose consciousness?

Question 4

What is syncope?

Answer 4

A transient loss of consciousness characterised by fast onset and spontaneous recovery.

Caused by a reduced perfusion pressure to the brain

Syncope is usually self limiting being horizontal with dox low blood pressure

Beware of people who have been help in an upright position

Question 5

What are pre-syncope symptoms?

Answer 5

Light headed ness
Sweating
Pallor
Blurred vision

Question 6

What are seizures

Answer 6

Not a syncope

Question 7

What are the three broad categories of syncope?

Answer 7

Reflex syncope

Orthostatic hypotension

Cardiac / cardiopulmonary disease

Question 8

What is reflex syncope?

Answer 8

Disorders f autonomic regulation of postural tone.

Activation of part of medulla leads to decrease in sympathetic output and increase and parasympathetic.

Fall in CO (reduce HR) and BP leads to reduced cerebral perfusion

Question 9

What are soem examples of reflex syncope?

Answer 9

Vasovagal

Question 10

What is orhostatic hypotension?

Answer 10

Symptoms occur after standing from a. Sitting or lying position.

Can cause syncope if drop in BP is severe enough

Normally defined as a drop of 20mg or more with pre-syncopated symptoms on standing.

Question 11

What is the problem with standing (why cause syncope)?

Answer 11

Standing up..

Question 12

Why does the baroreceptor reflex sometimes fail?

Answer 12

Baroreceptors become less sensitive with age.
Also become less sensitive with hypertension.
Medications such as anti-hypertensives can impair this response or venous return
Dehydration -lower blood volume.

Question 13

What is cardiac syncope?

Answer 13

Syncope caused by a cardiac disease or abnormality.

Can be electrical (rhythm), structural or coronary cause.

Question 14

What are some causes of cardiac syncope?

Answer 14

Electrical:

Structural:

Coronary: MI, IHD

Question 15

What is aortic stenosis?

Answer 15

Narrowing of the aortic valve

Harder to push blood through the aortic valve

If heart has to work harder, e.g. exercise can fail to adequately perfume brain.

If AS with syncope, then patient has a mean survival of 2-5 years.

Question 16

What are the features of cardiac syncope?

Answer 16

Exertional syncope

Family history of cardiac disease or sudden cardiac death

Preceding chest pain or palpitations

Past medical history of heart disease

Abnormal ECG

Question 17

What is a non-syncopal fall?

Answer 17

A fall in which the cause is not syncope

A fall with a loss of consciousness following a head trauma is still a non-syncopal fall.

Inc. trips and slips

Often the full can be the end result of inter current illness, such as an infection

Question 18

How are falls multifactorial?

Answer 18

E.g. osteoarthritis and diabetic neuropathy and infection.

Question 19

Why is a drug history important when talking to patients who have had a fall?

Answer 19

Polypharmacy

New meds?
Anti-hypertensives / anti-arrhythmias? -Long term?

Any drugs that induce drowsiness? -new analgesia, benzodiazepine, antidepressants, antipsychotics

Recent medication review?

Question 20

Why is a social history important?

Answer 20

Who do they live with?
Any help at home? Who pays?
Family close by?
Any stairs?
Any walking aids? 
Drink alcohol?
Smoke cigarettes?

Question 21

What investigations do you do for falls?

Answer 21

LSBP (live standing BP_
ECG
FBC and U&E
CK if long lie.

Symptom guided:
X-Ray
Echo
24 hour tape
CT

Question 22

What is rhabdomyolysis?

Answer 22

Rhabdomyolysis May result from any traumatic or medical injury to the sarcolemma.

Release of intracellular ion, myoglobin, CK and rates into the circulation

Canlead to electrolyte disturbances, DIC, renal failure and multi-organ failure.

Serum CK 5 times upper limit of normal

Common complication of a fall with a “long lie”

Question 23

What happens after having a fall?

Answer 23

Basic advice

OT assessment

Social work / PCC assessment

Opticians / audiologist

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