Falls
Causes
Falls are usually multi-factorial and consideration should be given to identify risk factors and manage where possible.
Symptoms
history is often non-specific, but it is important to establish if any symptoms present before the fall.
It is really important to determine if there was loss of consciousness as this usually requires further investigation.
Patients may state that they “blacked out” but this should be explored further as it is a common term of falls. A useful question to ask is if they recall hitting the floor when falling – if they recall this they are unlikely to have lost consciousness prior to falling.
check for environmental factors - footwear, stairs, rugs, carpet, pets, hoarding - consider need for blitz clean/fire brigade referral
check prodrome - weakness, dizziness/imbalance, visual disturbance, other neuro
background infection or other new acute illness?
consider
PHx - parkinsons, CVA, dementia
drug related mechanisms - anti
HTN, hypoglycaemic agents, anti-coag's
has there been a prolonged lie? - risk of AKI with rhabdomyolysis
Signs
A general examination should be performed, with specific focus given to:
Identification of any injury
Neuro exam - Vision, Limb power/sensation
Walking/gait/balance
-
look for evidence of long lie - creases, bruises
Tests
Management
Usual medications should be reviewed by a prescriber, doctor or pharmacist
The patient should be assessed for mobility/transfer aids if needed
Further referral for therapy review of further medical assessment (e.g. Falls Clinic, ACE clinic) should be considered
FRAX score should be performed on patients not on bone protection (e.g. alendronic acid), and subsequent advice reviewed and actioned as appropriate.
When to admit
If concern regarding acute fracture (or if unable to mobilise due to pain) - transfer to ED should be consider for further assessment of potential fracture
If head injury NICE guidance should be followed regarding the need for imaging
new focal neurology signs, confusion
If other concerns requiring admission
Author: Dr Chris Bell, Feb 2023