Risk and Fall Assessment and Management

1. Risk and FallAssessment and Management
By:Dr.Ahmad Sultan
MBChB, MRCEM,FJMC(A&E)
Specialist Emergency Medicine
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2. Disclosure
I do not have actual or potential conflict of interest or
any financial interest in commercial products or services
related to the subject of this CPD activity.
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3. Learning Objectives
At the end of this session, participants will be able
to:
• Know what is the Fall.
• Risks of Fall.
• Assessment of patient with history of Fall.
• Prevention of future Fall.
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4. Introduction
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5. Definition
Unplanned descent to the floor with or without
injury to the patient.
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6. EPIDEMIOLOGY
• The incidence of falls increases with age and varies
according to living status. Between 30 and 40
percent of community-dwelling people over the age
of 65 years fall each year , increasing to about 50
percent for those 80 years and older. In US data from
2014, there were an estimated 29 million falls, with
higher rates of falls among those with poor health.
Falls and fall injuries were reported more commonly
by women than by men.
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7. 8/30/2020 7

8. Risk Factors:
Intrinsic Factors:
• Age: >65 year.
• Gender: female ≥ 65.
• History of recent fall (within the past 1 year).
• Medication: Patient on 4 or more drugs or using medication that can cause
sedation, hypotension or altered cognition.
• Medical conditions.
• Impaired mobility and gait with balance deficit and use of assistive device.
• Cognitive and sensory deficits.
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9. Extrinsic factors:
• Environment hazards: Lack of space, proximity of furniture, poor lighting,
slippery floors, uneven surfaces, etc.
• Footwear and Clothing: Inappropriate footwear or clothing can affect postural
stability, or detract the person’s attention from the activity in hand.
• Inappropriate walking aids or assistive devices.
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10. Risks of fall
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11. 8/30/2020 11

12. Assessments
• History
• Examination
• Investigations
• Prevention from future fall
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13. History
• Fall ( mechanism of fall, Location, Activity, Injury related to the
fall, witness/help).
• Associated symptoms concurrent with a fall (change in level of or
loss of consciousness, chest pain, palpitations, dizziness, vertigo
or lightheadedness, Symptoms related to a change in position
,headache, weakness/tingling/numbness or acute change in
mental status).
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14. • Previous falls and whether the falls were the
same or different in character.
• Past medical history.
• Medications.
• Social history.
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15. Physical Examination
• General looking.
• Hydration status.
• Vital signs( orthostatic hypotension).
• Visual & Hearing abnormalities.
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16. • Cardiovascular: murmur ,presence of arrhythmias &
carotid bruits.
• Neurologic and mental evaluation.
• Musculoskeletal: lower-extremity weakness.
• Environmental assessment: Lighting, walking surface,
furniture, clothing, and equipment.
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17. • Evaluate gait: Recommended test:
Timed Up and Go.
Functional reach test.
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18. Investigations
• Complete blood count, Electrolyte, Blood urea nitrogen
, Creatinine , Glucose , Thyroid function, Vitamin D
levels.
• X-ray.
• ECG.
• ECHO, EEG.
• Brain imaging(CT/MRI).
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19. Consequence of falls
Physical:
- Skin tear
- internal bleeding
- subdural hematoma
- Hip fracture
- Immobilization
- disability
- Hospitalization
Psychological:
- Fear of falling
- increased dependency
- Depression
- Anxiety
- loss of confidence
- social withdrawal
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20. Treatments
• Treating of consequences.
• Treating underlying cause or causes.
• Prevention of future events.
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21. Prevention:
- Multiple preventive interventions including:
• Educational programs.
• Interventions to improve strength or balance.
• Optimize medications.
• Modify environmental factors in homes or
institutions.
- Some interventions have targeted a single risk
factor.
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22. Multifactorial assessments
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23. Prevention:
- Exercise.
-Medication modification.
-Vitamin D supplementation.
-Environment/assistive technology.
-Education.
-Multiple component interventions.
-Patients with comorbidities(Carotid sinus
hypersensitivity, Cataracts, Malnutrition, Postural
hypotension etc.).8/30/2020 23

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25. How to Document in PHCC:
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27. References
• PHCC policy
• www.Uptodate.com
• www.hse.gov.uk/
• https://www.cdc.gov/
• http://www.americangeriatrics.org
• www.Amedisys.com
• https://www.deprescribingnetwork.ca/
• NICE guideline of falls in elderly, assessment and
prevention.
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