What are the non- modifiable risk factors for falls?
- Age
- Gender
- History of falls
What are the neurological risk factors for falls?
- Cognitive impairment or Dementia
- Confusion/delirium
- Depression
- Poor vision
- Poor balance (arthritis, parkinson’s)
- Poor co-ordination
- Anxiety about falling
What are the environmental risk factors for falls?
- Home hazards
- Inappropriate footwear
- Insufficient home modification
What are the chemical risk factors for falls?
- Polypharmacy
- Drug culprits (e.g. corticosteroids)
- Alcohol
What are the cardiovascular risk factors for falls?
- Orthostatic hypotension (low blood pressure upon standing up)
- Arrhythmias
- Syncope (temporary drop in blood to the brain that causes fainting)
- Anaemia
What is collateral history?
Taking history of a patient from an onlooker or relatives.
How can you prevent falls?
- Clean up/declutter the environment
- Better feedback
- Do regular strength and balance activities (physiotherapy)
- Eyesight checks (optician’s)
- Reduce alcohol intake
- Correct low BP
What is delirium?
A worsening or change in person’s mental state that happens suddenly, over 1-2 days.
What are the 3 different types of delirium?
- Hyperactive
- Hypoactive
- Mixed
What are the symptoms of hyperactive delirium?
- Restlessness
- Agitation
- Delusions
- Hallucinations
- Disorientation
- Paranoia
What are the symptoms of hypoactive delirium?
- Withdrawn mood
- Drowsiness
- Unable to focus
- Less mobile
- Somnolent
What are the risk factors of delirium?
- Age
- Underlying cognitive impairment
- Social isolation
- Pain from fall
- Renal impairment
- Poor mobility (previous falls)
- Visual/hearing problems
- Alcohol
What are the triggers of delirium?
- Pain
- Infection
- Nutrition (deficiencies like Vit B12, folate, thiamine, Vit D)
- Constipation
- Hydration
- Medication (drug culprits)
- Electrolytes
What is the treatment of delirium?
1) Address the medical problem that caused it (correct glucose levels, stop medication that may be causing it, give antibiotics).
2) Ensure a supportive + calm environment for patient
What tests are carried out for a patient that’s had a fall and is delirious?
- ECG
- Blood tests
- Chest X-ray
- Urine sample (to test for UTIs)
- Hip X-ray
What are fragility fractures?
Fractures that result from mechanical forces that would not ordinarily result in a fracture (equivalent to falling from standing height).
What are the most common causes of fragility fractures?
- Osteoporosis
- Advancing age
- Other bone disorders (OI, acromegaly)
- Poor muscle strength
What is osteoporosis?
Reduction in the density of bone: bone is more porous because osteoclast activity > osteoblast activity. There is sequential trabeculae loss.
What are the risk factors for osteoporosis?
- Age: reduced Ca2+ / Vitamin D metabolism
- Female gender: loss of oestrogen means less inhibition of osteoclasts and less stimulation of osteoblasts
How is osteoporosis diagnosed?
- T score
What is the mechanostat theory?
Bone structure is influenced by mechanical loading. If there is a change in load, bone mass + structure will change.
If a patient is on bedrest, what will happen to their bones and muscle according to the mechanostat theory?
- Decrease in bone density (osteopenia initially)
- Atrophy of muscle due to disuse (sarcopenia)
What is sarcopenia?
- Progressive loss of muscle strength
- Usually comes with osteopenia
What are the most common sites for a fragility fracture?
- Vertebrae
- Hip (NOF)
- Wrist (Scaphoid bone)
