Falls

Question 1

what factors would you focus on when taking a falls history?

Answer 1

*cause, consequences, prevention of further

• before, during and after
• aftermath - pain, recurrent falls, confidence
• previous falls
• ICE
• systemic inquiry
• fracture risk - FRAX
• PMH, DHx, FHx, Sx

Question 2

what score is used to assess risk of recurrent falls?

Answer 2

FRAT score
- have you had any falls in the last year?
- are you on 4+ medications?
- do you have a diagnosis of stroke or Parkinson’s?
- are you able to get up from chair without using your arms?

<3 low risk & 3-5 high

Question 3

what types of conditions do you focus on in the PMH section?

Answer 3

• conditions affecting mobility, strength or balance
• affecting cognition
• affecting sensory elements
• conditions that lead to urgent movement
• CVS

Question 4

what types of drugs are revenant when investigating causes of falls?

Answer 4

• antihypertensives
• sedating drugs
• diuretics
• antidepressants (SSRI)
• anticholinergics: cause dizziness, affects vision etc

Question 5

what kind of broad causes are there for falls in the elderly?

Answer 5

• cardiac: arrhythmia
• neurological: stroke, neuropathy
• vasovagal
• intoxication - alcohol, pharmacological
• ENT: BPPV
• infection: UTI
• endocrine: hypoglycaemia
• MSK: arthritis
• environmental - lighting, uneven surfaces

Question 6

what examinations would you carry out in someone who’s suffered a fall?

Answer 6

• CVS, RESP
• GALS
• ECG
• BP lying and standing
• urine dip
• neuro
• ENT

Question 7

what investigations would you carry out in a patient who has suffered a fall?

Answer 7

• bloods: U&E, CRP, WCC, CK
• cognitive screen: AMT
• XR
• echo
• 48h cardiac tape
• CT, MRI head
• Dix-hallpike
• ACTH stimulation test?

Question 8

how would you manage a fall?

Answer 8

• treat underlying cause: infection, ENT
• treat aftermath: fractures
• med review, visual review
• alcohol detox
• OT review on house
• cognitive assessment
• physio rehab