What does DAME stand for?
- Drugs
- Ageing
- Medical causes
- Environmental
All contributing to falls
What medications cause postural hypotension?
- Nitrates
- Diuretics
- Anticholinergics
- Antidepressants
- Beta blockers
- L-dopa
- ACE-i
What are the other medications associated wtth fals?
Sedatives - opiates, benzodiazepines, codeine
What is the tinetti score?
/24
High = risk of falling
If a patient has had 1+ falls/considered high risk, how would you assess them?
Assess gait and balance
- Timed up and go test and/or turn 180 degrees test
What are the age-related changes that contribute to falls?
- Postural instability
- Reduction in VA
- Reduced baroreceptor sensitivity
- Reduced BMD
- Sarcopenia
- RAAS works less effectively
- LV diastolic dysfunction
- Conduction system disease
What are the peripheral causes of vertigo?
o Benign paroxysmal position vertigo (BPPV)
o Meniere’s disease
o Vestibular neuritis
o Acoustic neuroma
How do you diagnose and treat BPPV?
Diagnose - Dix-Hallpike manoeuvre
Treat - Epley manoeuvre
What are the central causes of vertigo?
o Migraine
o Brainstem ischaemia
o Cerebellar stroke
o MS
How do you diagnose postural/orthostatic hypotension?
Lying and standign BP
>20mmHg difference in systolic
What causes neurogenic OH?
o T2DM, Parkinson’s disease, SCLC
What causes non-neurogenic OH?
o Hypovolaemia, cardiac failure or venous pooling
o Cardiac impairment: MI and AS
o Reduced intravascular volume (dehydration, adrenal insufficiency)
o Vasodilation (fevers)
o Medications
What medications treat OH?
- Fludrocortisone
- Midodrine
When do you assess a patient for osteoporosis with FRAX?
o Any person >50 with a Hx of falls
o Women >65
o Men >75
When do you assess a patient for osteoporosis with DEXA?
- Any person >50 with Hx of fragility fractures
* <40 with a Rax of fragility fracture
