Falls Flashcards
(32 cards)
What should be included in the history of presenting complaint for a fall?
before - Time, activity at time of fall, location, events before (e.g. warning signs)
during - (e.g. LoC, injury)
after -(e.g. confusion, ability to get up)
What are key ‘before the fall’ symptoms to ask about?
Warning signs, dizziness, chest pain, palpitations
What are key ‘during the fall’ symptoms to ask about?
Incontinence
tongue biting
loss of consciousness
skin colour changes
injury
what hit floor first
What are key ‘after the fall’ symptoms to ask about?
Ability to get up, duration on floor, return to normal activity, confusion, speech or motor symptoms
What is the ‘falls cycle’?
Fall → fear of falling → reduced activity → decreased muscle strength/balance → increased fall risk → another fall
What general symptoms should be asked in a systems review for falls?
Fatigue and weight loss
What cardiovascular symptoms are important in falls history?
Chest pain and palpitations
What respiratory symptoms are relevant in a falls assessment?
Shortness of breath and cough
What neurological symptoms are relevant in a falls history?
Loss of consciousness, seizures, motor/sensory disturbance
What urinary symptoms are relevant in falls history?
Incontinence, urgency, dysuria
What GI symptoms are relevant in a falls assessment?
Abdominal pain, constipation, diarrhoea
What MSK symptoms are important to ask about in falls?
Joint pain and muscle weakness
What medications are commonly implicated in falls?
- antihypertensives
- diabetic meds
- benzodiazepines
- polypharmacy
- opioids
- anticholinergics: amitryptyline, oxybutynin
- beta- blockers
- diuretics
What bedside tests are done in falls assessment?
Observations, lying/standing BP, urine dipstick, ECG, AMT, BM
What blood tests are relevant in a falls workup?
FBC, U&Es, LFTs, bone profile
What imaging might be ordered for someone who has fallen?
CXR, CT head, echocardiogram
What other investigations may be considered for falls?
48-hour ECG tape
What are the key differentials for falls?
- Mechanical
- polypharmacy
- orthostatic hypotension
- bradycardia
- arrhythmias
- stroke
- neuropathy
- incontinence
- UTI
- hypoglycaemia
- arthritis
- BPPV
- multifactorial
What factors are considered in a falls risk assessment?
Gait
vision
hearing
medications
alcohol use
cognition
postural hypotension
continence
footwear
environment
bone health
What interventions are used for postural hypotension?
Review meds, improve hydration, fludrocortisone (unless HF), midodrine
How is bone health addressed in falls prevention?
Assess for osteoporosis
calcium/vitamin D
bisphosphonates
FRAX score
DXA scan
What advice can help prevent falls?
Stay active
well-fitting shoes
alarms/phones
non-slip mats
safety rails
walking aids
eat and hydrate well
regular sensory checks
avoid clutter and alcohol
What is the correct method to assess for postural hypotension?
Measure lying and standing BP; ≥20mmHg systolic or ≥10mmHg diastolic drop within 3 minutes
What are side effects of bisphosphonates?
Reflux
oesophageal erosions
atypical fractures
osteonecrosis of jaw/ear canal
