The Purple Book

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
• Lying and standing BP
• look for evidence of long lie - creases, bruises

Tests

• Depends on cases seen
• Delirium should be screened for (e.g. using 4AT test)
• Every patient should have a lying and standing BP
• In some cases of unexplained symptoms an ECG (if available) may be helpful

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.