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Flashcards in Falls Risk Deck (16)
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1

Who needs a falls risk assessment

At least 2 falls in last 12 months
Presented to A+E with fall
Gait or balance problem

2

What to cover in falls risk assessment history

Detail of fall - mechanical, postural hypotension, syncope, bowel/bladder
How many falls in last 12 months
Confidence in walking
Past medical history
Drug history
Social history - home hazard assessment
Osteoporosis risk assessment
Any previous intervention for falls risk?

3

What to cover in falls risk assessment examination

Vision
Pulse
ECG - arrhythmia, silent MI
CVS exam - aortic stenosis
Neuro exam - power, sensation
Knee examination
Examine feet and footwear
Standing and lying BP
Get up and go test

4

What features suggest cardiac syncope fall

Prodrome e.g palpitations, dyspnoea

5

Examples of drugs increasing falls risk

Antihypertensives
Diuretics
Antidepressants (TCA!!!)
Sedatives
Diabetic medication - wrong dose = hypoglycaemia
Anticholinergic burden (antihypertensives, diuretics, antipsychotics, Parkinson's, nitrates, opioids, PPIs, benzodiazepines, antimuscurinics, antiepileptics, antidepressants, chlorphenamine)

6

Examples of drugs increasing risk of falls related injuries

Anticoagulation

7

How to perform a lying and standing BP

Lying down for 5 minutes
Measure BP while lying, immediately after standing, 1 minute after standing and 3 minutes after standing

8

How to interpret a lying and standing BP

Postural hypotension if within 3 minutes of standing:
Systolic drops by at least 20mmHg
Diastolic drops by at least 10mmHg

9

Management of postural hypotension

Alter medication
Increase salt and water intake
If failed conservative management, trial fludrocortisone

10

How to perform a get up and go test

Patient uses usual mobility aid
Measure time take to rise from chair, walk 3m, turn around, walk back to chair and sit down.

11

What to look out for when examining gait

Foot drop
Shuffling
Trendelenberg
High stepping
Swinging out
Wide based
Narrow based
Veering off course
Antalgic
Parkinson
Festination - slow to stop

12

What professionals are involved in falls risk assessment

GP
Geriatrician
PT
OT

13

Management of high falls risk

Falls prevention programme - STEEP (stay steady exercise and education programme):
1 week of risk assessment
6 weeks of educational talks and 30min exercise circuit

14

Consequences of falls

Hospital admission (HAI, VTE, Pressure sores)
Fractures
Rhabdomyolysis and hypothermia in long lie
Loss of confidence
Loss of mobility
Deconditioning

15

What time of GUGT suggests high risk of mechanical fall

>12 seconds

16

Investigations for falls presenting to A+E

Depends on history:-
CT head
X ray for fractures
U+Es
Creatine kinase
Temperature