FALLS – A QUICK GUIDE
1. Poor Bone Health
Nearly all patients will be both calcium and vitamin D deficient and require supplementation with both.
Please check their calcium intake and if low start on calcium. Use calcium citrate if they are on a PPI or H2 antagonist
The recommended calcium intake is 1300mg a day.
A quick guide is 250mg = 1 serve calcium = 250ml Glass milk/2slicescheese/tub of yoghurt
The vitamin D level should be above 75. They may need a lot of vitamin D (up to 5 a day) depending on how low is the level. They can get hypo-calcaemic when they start vitamin D without enough calcium so it is advisable to recheck the corrected calcium after 10 days.
If they have had a fracture they are eligible for an anti-osteoporotic drug, which should be started once they are vitamin D replete. A Th spine XR showing a 20% decrease in vertebral height, is sufficient for the PBS criteria. A BMD is free for all patients over 70.
2. The patient is describing suddenly dropping to the ground and/or has sustained major facial injuries.
This suggests a cardiac cause, investigate them accordingly.
3. He/she is describing dizziness when standing.
Assess them for postural hypotension. Up to 50% of elderly people don’t drop their blood pressure until they have been standing for 5 minutes.
This is a way to assess this without wasting any time.
When the patient comes to see you ask them to lie down immediately. You can then take a history. After they have been lying for 5 minutes, take the BP. Then stand them up and take a blood pressure immediately, after 1 min of standing, then 3 and 5 minutes of standing. In the meantime you can write your notes and order tests.
4. The patient is describing postural dizziness in the morning.
This can often be related to high blood pressure overnight causing them to pass lots of urine overnight. If they have overnight high blood pressure,consider an evening dose of a blood pressure medication.
Often a 24 hour blood pressure monitor can be useful. They are available at a cost $79 through Melbourne pathology and are free if done at vascular services at DandenongHospital, phone number: 9554 8022.
4. The patient is falling backwards/walks like they a frontal gait pattern (shuffling wide based gait)/and/or we are concerned they have cognitive impairment.
This gait/balance pattern is often associated with small vessel ischaemic disease in the frontal lobe or normal pressure hydrocephalus. Perform a neurological examination, head CT and a dementia screen.
5. The patient has much more difficulty on even surfaces, when wearing thick shoes or in the dark.
These difficulties are often associated with peripheral neuropathy. Assess them for a peripheral neuropathy.
6. The patient has significant arthritis of a joint.
Review their management, consider a gait aid, referral to physiotherapy andthen if a rheumatology or surgical referral is indicated.
7. The patient is describing urgency/incontinence which may well be contributing to their falls risk.
Assess, manage and refer to continence clinic if indicated.
8. The cause for this patient is falling can’t be determined and/ or is complicated.
Consider a referral to the Falls and Balance Clinic at Kingston Centre. Please fax the referral to access and intake. Fax number: 9265 1297