Prevention and management of falls

Question 1

Risk factors for falls can be…

Answer 1

Intrinsic / Extrinsic

Question 2

Response to avoid a fall

Answer 2

Perception of a postural threat

Selection of an appropriate corrective response

Proper response execution

Question 3

Responsibilities of Physio

Answer 3

Assessment of gait, strength, balance and ROM and ensuring deficits are managed effectively.

Coping strategies to prevent a long lie.

Referral to other disciplines for multi-factorial assessment.

Question 4

NICE guidelines of ‘multi-factorial assessment

Answer 4

1) Identification of falls history
2) Assessment of gait, balance and mobility and muscle weakness.
3) Assessment of osteoporosis risk.
4) Assessment of the older person’s perceived functional ability and fear relating to falling
5) Assessment of visual impairment
6)Assessment of cognitive impairment and neurological examination
7)Assessment of urinary incontinence
8) Assessment of home hazards
9) Cardiovascular examination and medication review.

Question 5

Case/Risk identification & MFFRA

Answer 5

Older people in contact with healthcare professionals should be asked routinely whether they have fallen in the past year and asked about the frequency, context and characteristics of the fall.’

‘Older people who present for medical attention because of a fall, report recurrent falls in the past year or demonstrate abnormalities of gait and balance should be offered a multi-factorial risk assessment.’

Question 6

NICE clinical guideline: falls interventions

Answer 6

Individualised multi-factorial interventions including:

Strength and balance training
Home hazard intervention and follow up
Vision assessment and referral
Medication review / withdrawal

Question 7

Assessments

Answer 7

Gait
Balance
Muscle strength
Joint range of motion
Posture
Fear of falling
Confidence in balance

Question 8

Intervention

Answer 8

Management of strength, balance, gait and posture problems using individualised, progressive, evidence based exercise.

Question 9

Syncope

Answer 9

Syncope is a symptom - abrupt cerebral hypoperfusion resulting in transient, self-limited loss of consciousness, usually leading to falling.

The onset of syncope is usually rapid, the subsequent recovery is spontaneous, complete and usually prompt.

Question 10

Types of syncope

Answer 10

• Cardiac arrhythmias - bradycardia
• Neurally mediated reflex syncopal syndromes - vasovagal

Question 11

Non-syncopal causes of loss of consciousness

Answer 11

Seizures

Associated with focal neurological signs/symptoms – TIA

Frequent attacks with no organic heart disease

Question 12

Causes of dizziness

Answer 12

Orthostatic Hypotension

Medication

Benign Paroxysmal Positional Vertigo

Ear Wax

Central neurological causes e.g. brain tumour

Question 13

Orthostatic hypotension

Answer 13

• Patient may feel dizzy before hand.
• History of dizziness on changing position from lying to standing or sitting to standing.
• May cause enough cerebral hypo perfusion to cause the patient to fall because they feel significantly unsteady.
• Systolic drop of 20mmHg or diastolic drop by more than 10mmHg constitutes a postural drop.

Question 14

Previous fractures

Answer 14

• Risk of osteoporosis
• Record details of fracture site and the circumstances they broke a bone in.
• Medical management and treatment.

Question 15

Vision

Answer 15

Poor vision is associated with an increased risk of falling and an increased risk of associated injury

Age-related changes:
- Depth perception
- Opaque lens
- Slower reaction to light
- Impaired contrast sensitivity

Question 16

Medication

Answer 16

Polypharmacy – multiple medication use may lead to falls as a result of adverse effects.

Medications noted to cause falls:
- Psychotropic medication
- Anti-arrthymthmic medication
- Diuretics
- Anti-Parkinsonian drugs

Question 17

Osteoporosis

Answer 17

Osteoporosis is defined as a skeletal disorder characterised by compromised bone strength predisposing a person to an increased risk of fracture.

Question 18

WHO criteria for the diagnosis of osteoporosis

Answer 18

T- score

Normal >-1.0
Osteopenia -1 to -2.5
Osteoporosis < -2.5
Established osteoporosis <-2.5 + presence of one of more fractures.

Question 19

Teaching older people to get up from the floor

Answer 19

Contraindications:-

• Physical frailty
• Pain
• Unstable cardiac problems
• Unsuitable environment
• Excessive fear
• Recent hip replacement / hemiarthoplasty
• Risk to staff / patient
• Current acute orthopaedic injury – soft tissue / fracture.
• Gradual approach – a skill not a task.