highest risk old, females

1/4 fall/year but few tell thei dr

price of falling

• 1 fall 2x chance of another
• 30% can resiult in moderate/severe injury
• fear of falling, avoidance behaviours, isolation, lower QoL
• precipitate move to aged care

why old people fall:

• multifactorial
• intrinsic: pt factors. previous falls, walking/balance difficulty
  • MSK/sensory defecit
  • cognitive impairment
  • barriers to self awareness, underestimate falls risk
  • consequence of pain, postural hypotension, subdural haematoma, syncope
• extrinsic: environment factors
  • polypharmacy
  • substance abuse
  • enzironmental hazards (poor lighting, loose ground, clutter)
  • malfunctioned mobility aids

workup

• Hx
  • mechanism
  • LOC/head strike
  • neuro/CVS symptoms
  • recently unwell?
  • PMHx meds etc
  • previous falls?
  • osteoporosis?
  • possible complications? (long lie, rhabdo, soft tissue injury, fracture, ICH, hypoglycaemia)
  • screening of geriatric syndromes
• Ex - look for causes of fall and assess complications
  • vitals — GCS, resp + O2, HR and rhythm, BGL
  • hydration status
  • sensory - hearing aids, glasses
  • peripheries for injury
  • cognitive testing (4AT)
  • CVS incl postural BP
  • MSK
  • neuro
  • gait