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Common cause of admission in the elderly

Fall - inadvertently coming to rest on the

ground +/- loss of consciousness Fall > Loss of confidence > Dependency

Explained fall - slip, trip or environmental hazard

Unexplained fall - no apparent cause
Not a diagnosis - common end poinf for a
number of pathologies

CNS disease; visual impairment; cognitive impairment

MDT Assessment
Depression; postural hypotension; peripheral neuropathy
Exercise programmes
Medication; pain; muscle weakness; alcohol
Modify risk factors Management Polypharmacy; cardiovascualar; acute illness
Treat underlying disorders Neuro causes: extra pyramidal (Pd, Huntingtons); cerebellar ataxis; sensory ataxia
Management of osetoporosis Phenytonin (anti epilepsy) - long term use can produce a cerebellar syndrome and osteomalacia
Verapamil + beta blocker can produce heart block
Falls Causes Cataplexy - flacid muscles after strong emotions
Narcolepsy syndrome Hypnogogic - hallucinations
FBC, U&E, Glucose
TFTs, B12 Bloods
Neuropathy: inflammatory (MS), genetic (CMT), autoimmune (DM), vitamin B12 deficiency
ECG Calcium deposits develop with age in semi circular canals
Benign Paroxysmal Positional Vertigo
CT Head These deposits can stimulate sensation of movement
EEG Poor lighting; uneven surface
Used to diagnose caortid sinus syncope
Carotid Sinus Massage
Used to demonstarte syncope related to
postural hypotension
Tilt Table Test
Test for proprioception (dorsal columns)
Positive test (swaying with eyes closed) suggests ataxia is sensory
Romberg's Test Complications Hypothermia
Patient stands, feet together with eyes closed for minute
Muscle breakdown releases myoglobin
Often use superficial peroneal nerve which can build up and cause renal failure
Nerve biopsy Rhabdomyolysis

Falls.mmap - 08/09/2010 -