Falls
Epidemiology:
1/3 or 65+ fall. 1/2 become chronic fallers
Risk Factors
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Environmental:
Unsafe stairs, loose carpets, bathtubs w/o rails, slippery floors, lighting
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Drugs:
Especially sedatives or those inducing postural hypotension
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Disease/Degenerative:
Dementia, poor vision, stroke, Parkinsons
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Nutritional:
Undernutrition, Ca & vit D deficiency
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Lack of exercise
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Behavioural
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Syncope
Consequences
↓Mobility: pain, stiff, weak, depression, dependence.
↓Confidence.
Clinical Workup
Examination
CVS, orthopaedic, neurological
Investigation
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Postural hypotension: supine for 5m then measure BP. Stand up & measure. Measure again after 2m. +ve if ΔBP>20
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Tilt Test: Supine BP, tilt bed to 70o. Cant move legs (cannot redistribute blood. BP every 5m for 40m)
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XRs: fractures
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Anaemia, hyponatraemia, hypothyroidism
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ECG, 24h ECG
Treatment
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Treat injuries
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Psychological support
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Rehab: POSSET
(physio, occupationel therapy, social-services, education)
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Prevention
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MDT
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Physical: balance training, elastic bands
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Hip protection: external fitted shock absorbing pads (but uncomfortable)
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Exercise
