Osce - falls

Question 1

Intrinsic factors in falls

Answer 1

1. Balance and Gait
2. Vision
3. Cognitive problems
4. Cardiovascular (BP)
5. Urinary Incontinence

Question 2

Extrinsic factors in falls

Answer 2

1. Footwear
2. > 4 medications
3. Lighting
4. Stairs
5. Rugs
6. Lack of equipment

Question 3

Diseases that can affect balance and gait

Answer 3

Stroke
Parkinsonism
Arthritis
Neuropathy

Question 4

Medications and their effects

Answer 4

Side effects
Polypharmacy
Sedatives
Cardiovascular (postural hypotension)

Question 5

Visual impairment

Answer 5

Glaucoma
Cataract
ARMD
Retinopathy

Question 6

Cognitive problems in falls

Answer 6

Dementia

Delirium

Question 7

Cardiovascular problems in falls

Answer 7

Orthostatic hypotension
arrhythmias
Structural heart disease

Question 8

Continence and falls

Answer 8

Urgency and frequency can precipitate falls

Question 9

History in falls

Answer 9

Loss of consciousness?
First or multiple?
Eye witness account?
Associated features?
Risk for Falling?
Drug history?
Alcohol intake?

Question 10

Examinations?

Answer 10

a. Gait
b. Postural BP
c. Heart sounds
d. Neurological assessment (including cognition eg. MOCA)
c. Eye sight

All is leading up to an MDT ASSESSMENT which involves physio and OT (looking at housing etc)

Question 11

Prevention of future falls

Answer 11

Hip protectors
Regular exercise with Physio
Treatment for osteoporosis (Vit D!!)

Review and monitor
medications/ medical problems

Environmental assessment (OT) (Home hazard Assessment)

Question 12

Assessments in falls

Answer 12

Multifactorial falls risk assessment

Consider Vit D, Calcium and bone health assessment.
FBC, CRP, ESR - INFECTION?
Everyone should have ECG

Neurological assessment