what is a fall?
an unexpected event in which the participant comes to rest on the ground, floor or lower level
what are some intrinsic factors that can increase the risk of falls?
age related changes medical conditions cognitive problems impaired vision and hearing fear of falling
what environmental factors can increase risk of falls?
medications environmental hazards inadequate lighting inappropriate footwear inappropriate use of walking aids
name five types of drugs that can alter falls risk
diuretics anti hypertensives sedatives anti cholinergics hypoglycaemic agents
what effect do psychotropics have on falls risk?
increases - stopping can reduce risk
what effects can long term phenytoin use have?
permanent cerebellar damage and unsteadiness
what blood pressure is associated with an increased risk of falls in the elderly?
systolic BP of 110mmHg
what anti-hypertensives should be stopped in patients with high falls risk?
no evidence of congestion = reduce diuretics
what is the most common neurological cause of ataxia in the elderly?
when is peripheral neuropathy considered to be functionally significant?
loss of heel reflexes
decreased vibratory sense
impaired position sense at the great toe
inability to maintain unipedal stance for 10s in 3 attempts
what is the most common cause of syncope in the elderly?
how is orthostatic hypotension diagnosed?
confirmed by BP testing
what is the conservative management of orthostatic hypotension?
stop culprit drugs
water loading + increased salt
keep legs elevated when possible
what medications can be considered for orthostatic hypotension?
what is a drop attack?
when someone suddenly collapses without any preceding symptoms and without apparent loss of consciousness
what investigations should be done for falls?
timed up and go
if indicated = ECHO, CT etc.
when is an urgent plain CT brain recommended in a head injury?
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
when should a CT scan be done within 8 hours of a head injury?
loss of consciousness/amnesia and any one of:
- dangerous MOA
- clotting disorder
- 30 mins retrograde amnesia
what is the carotid sinus?
an area of dilatation in the ICA
contains a number of baroreceptors