Falls

Question 1

Medications that are a risk for falls? (6)

Answer 1

Polypharmacy, 
Sedative meds e.g. night sedation or strong analgesics, 
Diuretics due to needing to wee more, 
Anti hypertensives, 
Glucose lowering meds, 
Anticholinergics

Question 2

What info would you like to know about fall?

Answer 2

Indoors/outdoors, 
Trip, 
Faint, 
Triggers e.g. lighting, 
Associated symptoms, 
Injuries, 
How after, 
Any witnesses?, 
Patient’s thoughts of cause

Question 3

What aspects of PMH are important to consider in falls PC?

Answer 3

Arthritis, 
Sensory impairment, 
Cognitive impairment, 
Previous stroke, 
Neuro condition affecting balance,
Parkinsons 
Strength/mobility, 
Vertigo, 
Cardiac history, 
DM, 
incontinence

Question 4

50% of over what age fall at least once a year?

Answer 4

over 80s

Question 5

hip fracture prognosis?

Answer 5

1/3 mortality,
1/3 morbidity,
1/3 recover

Question 6

Lust 6 motor, sensory and biomechanics reasons for increased falls in older people

Answer 6

worse vision: smaller pupils, lens thickening so decreased light,
sarcopenia: loss of muscle mass and function,
decreased cardiorespiratory fitness,
decreased reaction time due to decline in central processing and cognition,
decreased peripheral sensation and proprioception,
increased postural sway

Question 7

List 4 extrinsic risk factors for falls other than medication

Answer 7

environment rugs, stairs,
inadequate lighting,
inappropriate footwear,
inappropriate use of walking aids

Question 8

Why does a fear of falling lead to increased risk of falls?

Answer 8

Leads to cautious gait which is slower walking and shorter steps -> more time with both feet on the ground

Question 9

What is annual incidence of falls in patients with cognitive impairment/dementia?

Answer 9

70-85%

Question 10

Mortality post hip fracture in mild to moderate cognitive impairment is 5 times the rate for those without. T/F?

Answer 10

T

Question 11

What assessment should be done on falls patients to assess cognition?

Answer 11

4AT +/- MMSE/MOCA

Question 12

Bifocal glasses decrease falls risk. Improving vision results in decreased falls risk. T/F?

Answer 12

F - actually increases risk for both, when vision rapidly corrected for old people

Question 13

Patient presenting with fall says they “misjudged the curb”, what is that a common presentation of?

Answer 13

Visual distortion due to AMD

Question 14

How many meds do you need to be on to have an increased fall risk?

Answer 14

4 or more