Geriatrics- Falls

Question 1

List some of the potential causes of falls in older people.

Answer 1

MSK related
Drugs
Neurological
Sensory
Cardiovascular
Being generally unwell
Incontinence

Question 2

MSK causes of falls?

Answer 2

Deformities of feet
Muscle weakness
Osteoarthritis
Kyphosis- hunched over, altered centre of gravity

Question 3

Which drugs are most likely to make you fall?

Answer 3

Anti-hypertensives
Sedatives, alcohol

->vast majority of drugs cause falling.
->also note that cannabis is becoming more common in older people as those who grew up smoking weed in the 70’s are getting older!!

Question 4

Neurological causes of falls?

Answer 4

Stroke- old or new
Dementia
Parkinsonism
Delirium
Ataxia

Question 5

Sensory cause of falls?

Answer 5

Visual impairment
Inattention
Hearing

Question 6

Cardiovascular causes of falls?

Answer 6

Postural hypotension
Arrhythmias
Heart failure
Aortic stenosis

->Don’t miss aortic stenosis!! Aortic stenosis is the most important murmur to hear as can cause sudden death. Is the easiest heart murmur to hear.

Question 7

Why may incontinence cause falls?

Answer 7

Patient may be rushing to the toilet

Question 8

Why can drugs cause falling?

Answer 8

Decrease BP, HR and awareness
Increase dizziness, urine output, sedation, hallucinations

Question 9

List some of the drugs that are most likely to cause falls.

Answer 9

Antihypertensive
Beta blockers
Sedatives
Anticholinergics
Opioids
Alcohol

Question 11

How do you assess someone who has falled?

Answer 11

Take a detailed history, especially describing the fall

Question 12

Falls clinics involve am MDT approach.
What would the nurse do?

Answer 12

Eye test, ECG, Lying and standing BP, incontinence questionnaire

Question 13

Falls clinics involve am MDT approach.
What would the physiotherapist do?

Answer 13

Full assessment of gait and balance

Question 14

Falls clinics involve am MDT approach.
What would the doctor do?

Answer 14

Thorough history and examination, consider bone health and osteoporosis screening

Question 15

If a patient collapses with no memory, what would you be suspicious of?

Answer 15

Syncope?
Cognition related?

Question 16

If a patient collapses with a clear memory of trip, what would you be suspicious of?

Answer 16

Sensory related- eyes, nerves

Question 17

If a patient collapses with palpitations preceding fall and no tripping, what would you be suspicious of?

Answer 17

Cardiac related

Question 18

If a patient collapses on turning, what would you be suspicious of?

Answer 18

Postural instability

Question 19

If a patient collapses with syncope on exertion, what would you be suspicious of?

Answer 19

Aortic stenosis

Question 20

Examination with somebody who has fallen?

Answer 20

Head and arms
Cranial nerves
Kyphosis
Pulse, heart sounds
Feet
Sensation, vibration, proprioception
Romberg’s test
Assess gait

Question 21

What causes an ataxic gate?

Answer 21

Cerebellar gait

Question 22

What causes an arthralgia gate?

Answer 22

Arthritis

Question 23

What causes an hemiplegic gate?

Answer 23

Stroke

Question 24

What causes of small steps, shuffling gait?

Answer 24

Parkinsonism

Question 25

What causes a high-stepping gait?

Answer 25

Peripheral neuropathy

Question 26

When may you need to do a CT after a fall>

Answer 26

Low GCS <13 Still confused after 2hrs Focal neurology Signs of skull fracture Vomiting Seizure Basal-skull fracture Anti-coagulation

Question 27

What might cause falls as an inpatient?

Answer 27

All the same things as outpatients and…. Patient getting postural hypotension (or just hypotension) due to illness Or new medication Low blood glucose Or getting sicker Delirium De-conditioning Call bell out of reach, no appropriate footwear.