Falls Flashcards
What are the 3 main factors of falls?
The patient
- Illness and comorbidities
- Age-related issues
- Acute additional problems
Environment e.g. hazards
Activity
Give examples of cardiovascular causes of falls
Arrhythmias Postural/Orthostatic hypotension Valvular disease Carotid sinus hypersentivity Syncope and pre-syncope
Give examples of neurological causes of falls
Parkinson’s
Lumbar stenosis
Cervical myelopathy
Peripheral neuropathy
Give examples of ophthalmological causes of falls
Cataracts (so cataract surgery reduces falls risk)
Bifocal/Varifocal lenses (alter depth perception)
Age-related eye issues
Give examples of vestibular causes of falls
Balance issues
Vertigo e.g. BPPV
Why should you check patient gait?
2/3 of falls patients have gait problems
Gives you a clue to the underlying issue
Name some extrinsic factors contributing to falls
Medications Alcohol Polypharmacy Environment Inappropriate footwear Wrong use of walking aids
List investigations for falls
Falls assessment (history and examination) Standing and lying down BP check Screening tools
What should you include in a falls history?
How many falls the patient has had (2+ in 1 year?) Issues in walking and balance Fall details Witness accounts Medications
What should you include in a falls examination?
Assessment of gait and use of walking aids
ABCDE
Neurological, cardiovascular and/or MSK examinations
Visual acuity
How is BP checked in a falls case?
1st BP checked after patient lying down for 5 minutes
2nd BP checked within 1 minute of patient standing
3rd BP checked after patient standing for 3 minutes
What screening tools are used for falls?
Time up and go test Fracture assessment (injury, osteoporosis, weakness etc.
What is involved in the management of falls?
Balance and strength training 3x a week for 12 weeks
Patient education
STOP START tool to review patient medications
Environmental modifications
Appropriate footwear and walking aids
Manage medical issues
