Falls in the Elderly

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Features

-  Predisposing Factors

-  Cognition

-  Chronic disease

-  Poor vision

-  Balance/gait/proprioception

-  Muscle weakness, arthritis

-  Home hazards, footwear

-  Normal ambulation: 4WW, stick, wheel chair

-  Dizziness

-  Hx of falls

-  Precipitating

-  Meds: 4+ or psychoactive

-  Acute illness: UTI, pneumonia..

-  Postural hypotension

-  EtOH, drugs

 

Reported Causes

-  Accident 40%

-  Unknown 20%

-  Syncope 10%

-  CNS Lesion 7%

-  Postural Drop 3%

 

Causes

-  Mechanical ie: accident

-  Syncope

-  Stroke/TIA (massive, reticular, brainstem)

-  AMI, VF arrest

-  Seizure

-  Drop attack

-  Vertigo

-  Orthostatic hypotension

 

DDx elder abuse

 

Assocaited S/S

-  Malnutrition

-  Bleeding

-  Prolonged immobilisation

-  Rhambdomyolysis

-  Head injury

-  Fractures

-  Fall from height onto feet: calcaneal fracture

-  Elderly: NOF

 

Ix

-  Eye Exam

-  Cardiac exam

-  Neuro exam

-  GCS

-  Balance/Gait

-  Neuro defecit: Head injury, Stroke/TIA

-  Vitals

-  BP: postural drop

-  Fever: sepsis

-  Septic Workup even if afebrile

-  +/- Delerium work up

-  Imaging as indicated

-  Low threshold for CT – Brain

-  X-rays of painful parts

-  ECG: dysrhythmias, AMI

-  FBE: sepsis, anaemia

-  U&E: electrolye derangement, rhabdomyolysis

-  +/- CK: rhabdomyolysis

-  +/- Trop: AMI

 

Mx

-  As per cause

-  +/- medication r/v

-  As per associated injuries

-  OT, Physio, SW r/v