Adult Medical Emergency Handbook - Scottish Intensive Care Society

FALLS AND IMMOBILITY
Falls and unsteadiness are very common in older people. Although
only 10-15% of falls result in serious injury, they are the cause of 92%
of hip fractures in older women. There is now a good evidence base for
falls and fracture prevention.
PROBLEMS THAT MAY PRESENT AS A “FALL” OR “OFF LEGS”
Bear in mind that many patients will be in more than one of these
categories:
• Loss of consciousness: syncope or seizure.
• Acute illness e.g. infection, stroke, metabolic disturbance.
• Simple trip.
• Chronic neurological and locomotor disease (see below).
ASSESSMENT
Full history and examination are required:
• Ask about the circumstances of the fall, and frequency if they are
recurrent
• Try to establish if the patient lost consciousness e.g. “do you
remember hitting the ground?”. A witnesses account is best.
• Check for symptoms or signs of acute illness, especially infection.
• Find out the past history - if necessary ask the relatives and GP.
Conditions associated with falls:
- Stroke and vascular dementia.
- Parkinson’s disease.
- Alzheimer type dementia.
- Disease of weight bearing joints e.g. OA, joint replacement or
previous fracture.
- Depression.
• Look for the known risk factors for falls (many patients will have
several):
- Impaired cognitive function: check the AMT.
- Poor balance: ask and examine the patient’s gait.
- Reduced strength: grade 1-5 and look for wasting.
- Poor vision: ask and check eyesight.
- Postural hypotension: ask about dizziness on standing up and
check erect and supine blood pressure and drug treatment.
adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11
239