Disease - Falls

From CambridgeNotes

LOOK for a cause and TREAT it!

History and Examination

  • Ask about injuries sustained
  • Clues as to cause: memory (black out); context (postural, positional); features of a fit; dizziness (cardiac or drug); light-headed, nausea and vomiting, sweaty (syncope); palpitations; multiple drugs
  • Examine relevant systems; always check vision, hearing, gait, feet, shoes, postural blood pressure; check for any injuries sustained during fall, also check mental status

Differential Diagnosis

  • Impaired sensory input
  • Drug related
  • Gait abnormalities
  • Reduced cerebral perfusion
  • Epilepsy
  • Dizziness and unsteadiness
  • Psychiatric
  • Effects of aging:
    • Increased body sway (F>M)
    • Reduced reaction time and reduced reflexes
    • Walking patterns less efficient and more irregular
    • Don’t forget external factors (e.g. poor lighting, walking aids, unfamiliar environment, pets)

Investigations

  • MSU
  • ECG
  • FBC, U&E, CK, LFT, TFT, CRP, bone profile
  • Others to establish cause or assess injuries
    • Plain films, chest X-ray
    • 24 hr tape, echo, tilt table testing
    • CT
    • EEG

Treatment

  • Manage any immediate consequences of falls
  • Treat specific causes e.g. infection
  • Reduce risk factors e.g. polypharmacy, osteoporosis
  • Improve general health (e.g. Tai Chi) and provide education and support

Complications

  • Physical injuries
  • Psychological e.g. anxiety
  • Social
  • Death
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