Falls Risk

Question 1

Who needs a falls risk assessment

Answer 1

At least 2 falls in last 12 months
Presented to A+E with fall
Gait or balance problem

Question 2

What to cover in falls risk assessment history

Answer 2

Detail of fall - mechanical, postural hypotension, syncope, bowel/bladder
How many falls in last 12 months
Confidence in walking 
Past medical history 
Drug history 
Social history - home hazard assessment 
Osteoporosis risk assessment 
Any previous intervention for falls risk?

Question 3

What to cover in falls risk assessment examination

Answer 3

Vision
Pulse
ECG - arrhythmia, silent MI
CVS exam - aortic stenosis 
Neuro exam - power, sensation 
Knee examination
Examine feet and footwear
Standing and lying BP
Get up and go test

Question 4

What features suggest cardiac syncope fall

Answer 4

Prodrome e.g palpitations, dyspnoea

Question 5

Examples of drugs increasing falls risk

Answer 5

Antihypertensives
Diuretics
Antidepressants (TCA!!!)
Sedatives
Diabetic medication - wrong dose = hypoglycaemia
Anticholinergic burden (antihypertensives, diuretics, antipsychotics, Parkinson’s, nitrates, opioids, PPIs, benzodiazepines, antimuscurinics, antiepileptics, antidepressants, chlorphenamine)

Question 6

Examples of drugs increasing risk of falls related injuries

Answer 6

Anticoagulation

Question 7

How to perform a lying and standing BP

Answer 7

Lying down for 5 minutes

Measure BP while lying, immediately after standing, 1 minute after standing and 3 minutes after standing

Question 8

How to interpret a lying and standing BP

Answer 8

Postural hypotension if within 3 minutes of standing:
Systolic drops by at least 20mmHg
Diastolic drops by at least 10mmHg

Question 9

Management of postural hypotension

Answer 9

Alter medication
Increase salt and water intake
If failed conservative management, trial fludrocortisone

Question 10

How to perform a get up and go test

Answer 10

Patient uses usual mobility aid

Measure time take to rise from chair, walk 3m, turn around, walk back to chair and sit down.

Question 11

What to look out for when examining gait

Answer 11

Foot drop
Shuffling
Trendelenberg 
High stepping
Swinging out
Wide based
Narrow based
Veering off course
Antalgic
Parkinson 
Festination - slow to stop

Question 12

What professionals are involved in falls risk assessment

Answer 12

GP
Geriatrician
PT
OT

Question 13

Management of high falls risk

Answer 13

Falls prevention programme - STEEP (stay steady exercise and education programme):
1 week of risk assessment
6 weeks of educational talks and 30min exercise circuit

Question 14

Consequences of falls

Answer 14

Hospital admission (HAI, VTE, Pressure sores)
Fractures
Rhabdomyolysis and hypothermia in long lie
Loss of confidence
Loss of mobility
Deconditioning

Question 15

What time of GUGT suggests high risk of mechanical fall

Answer 15

> 12 seconds

Question 16

Investigations for falls presenting to A+E

Answer 16

Depends on history:-
CT head
X ray for fractures
U+Es
Creatine kinase
Temperature