Falls

Question 1

what is a fall?

Answer 1

an unexpected event in which the participant comes to rest on the ground, floor or lower level

Question 2

what are some intrinsic factors that can increase the risk of falls?

Answer 2

age related changes 
medical conditions 
cognitive problems
impaired vision and hearing 
fear of falling

Question 3

what environmental factors can increase risk of falls?

Answer 3

medications
environmental hazards
inadequate lighting 
inappropriate footwear
inappropriate use of walking aids

Question 4

name five types of drugs that can alter falls risk

Answer 4

diuretics
anti hypertensives
sedatives
anti cholinergics
hypoglycaemic agents

Question 5

what effect do psychotropics have on falls risk?

Answer 5

increases - stopping can reduce risk

Question 6

what effects can long term phenytoin use have?

Answer 6

permanent cerebellar damage and unsteadiness

Question 7

what blood pressure is associated with an increased risk of falls in the elderly?

Answer 7

systolic BP of 110mmHg

Question 8

what anti-hypertensives should be stopped in patients with high falls risk?

Answer 8

nitrates
CCB’s
vasodilators
no evidence of congestion = reduce diuretics

Question 9

what is the most common neurological cause of ataxia in the elderly?

Answer 9

peripheral neuropathy

Question 10

when is peripheral neuropathy considered to be functionally significant?

Answer 10

loss of heel reflexes
decreased vibratory sense
impaired position sense at the great toe
inability to maintain unipedal stance for 10s in 3 attempts

Question 11

what is the most common cause of syncope in the elderly?

Answer 11

orthostatic hypotension

Question 12

how is orthostatic hypotension diagnosed?

Answer 12

typical history

confirmed by BP testing

Question 13

what is the conservative management of orthostatic hypotension?

Answer 13

stop culprit drugs
avoid triggers
water loading + increased salt
keep legs elevated when possible

Question 14

what medications can be considered for orthostatic hypotension?

Answer 14

fludrocortisone

midodrine

Question 15

what is a drop attack?

Answer 15

when someone suddenly collapses without any preceding symptoms and without apparent loss of consciousness

Question 16

what investigations should be done for falls?

Answer 16

ECG
blood glucose
postural BP
timed up and go

if indicated = ECHO, CT etc.

Question 17

when is an urgent plain CT brain recommended in a head injury?

Answer 17

GCS <13
GCS <15 2 hours after injury 
suspected open/depressed/base of skull fracture 
post traumatic seizure
new focal neurology 
2+ episodes of vomiting

Question 18

when should a CT scan be done within 8 hours of a head injury?

Answer 18

anti-coagulated

loss of consciousness/amnesia and any one of:

• 65+
• dangerous MOA
• clotting disorder
• 30 mins retrograde amnesia

Question 19

what is the carotid sinus?

Answer 19

an area of dilatation in the ICA

contains a number of baroreceptors