Falls

Question 1

define a fall

Answer 1

unexpected event in which the participant comes to rest on the ground or floor

Question 2

list some reasons why older people are more likely to fall

Answer 2

sarcopenia 
smaller pupils - less light getting in 
reduced cardio fitness
reduce reaction time 
increased postural sway 
reduced bone and joint stability

Question 3

list some intrinsic risk factors for falls

Answer 3

medical conditions
cognitive impairments
impaired vision and hearing
age related changed to posture and gait

Question 4

list some medical conditions that increase falls risks

Answer 4

diabetes leading to peripheral neuropathy
Parkinsons and stroke affecting balance and gait
incontinence leading to needing to rush to toilet
arthritis
vision problems/incorrect glasses
obesity

Question 5

list some extrinsic risk factors for falls

Answer 5

medications
environmental - rugs
inadequate lighting
inappropriate footwear

Question 6

list some medications that the side effects can increase risk of falls

Answer 6

antihypertensives 
diuretics 
sedatives/benzos 
anticholingergics 
hypoglycaemic agents

Question 7

the fear of falling increases risk of falls true/false

Answer 7

true - cautious gait develops and this reduces length of stride

Question 8

which type of glasses are associated with the greatest falls risk

Answer 8

bifocals and varifocals

Question 9

which medications can cause orthostatic hypotension

Answer 9

anticonvulsants
antidepressants
antihypertensives
benzodiazepines

Question 10

which medications can cause sedation/drowsiness

Answer 10

anticonvulsants
antidepressants
benzodiazepines

Question 11

which medications can cause syncope

Answer 11

beta-blockers
nitrates
vasodilators such as alpha-blockers

Question 12

which medications can cause visual disturbances

Answer 12

anticholingergics

Question 13

stopping psychotropic drugs will greatly reduce falls risk true/false

Answer 13

true - particularly venlafaxine, risperidone, haloperidol

Question 14

a BP of what reading is associated with increased falls in the elderly

Answer 14

110mmHg systolic

Question 15

which antihypertensives are protective in cardiac failure and which antihypertensives should be stopped if orthostatic hypotension is present

Answer 15

ACEi and beta-blockers are protective

NICE recommends stopping nitrates, CCBs and vasodilators

Question 16

list clinical features of significant peripheral neuropathy

Answer 16

loss of heel reflexes
decreased vibratory sense that improves proximally
inability to maintain unipedal stance for 10 seconds

Question 17

outline the management of orthostatic hypotension

Answer 17

stop any culprit drugs
tell patient to avoid sudden changes in posture
water loading
increase salt intake
potentially compression stockings
elevate legs when sitting/sleeping
if conservative management fails, consider fludrocortisone

Question 18

outline the elements of a falls examination

Answer 18

general observations 
bony injury to vertebrae, hips or pelvis 
postural BP or murmur 
gait 
neuro exam 
visual exam 
AMTS or MOCA

Question 19

what is the best management for reducing falls risk

Answer 19

balance and strength exercises such as Tai Chi