Creating Waves of Awareness
Falls and ‘off legs’
If a person falls on ground suddenly, and is brought to you, it is very difficult to make the case history. Hereunder are given some important points to consider.
Points to assess in the case after a fall
• Circumstances of fall (e.g. place, time of day, witnessed)
• Symptoms before fall (e.g. presyncope/ syncope, palpitations)
• Injuries sustained
• Contributory factors (e.g. dementia, previous stroke, parkinsonism, lower limb joint disorders, foot disorders)
• Previous falls if any
• Previous syncope
• Usual effort tolerance (e.g. able to climb stairs; able to walk on ﬂat; able to manage activities of daily living)
• Walking aids if used
• If fall at home, are there environmental hazards (ask family/carer), e.g. loose rugs, poor lighting, slippery floor?
• Current medications (e.g. sedatives, hypnotics, antidepressants, antihypertensives, multiple drugs)
• Alcohol history
• Social history: living at home or residential/ nursing home resident?
• Key observations and systematic examination
• Injuries sustained (head injury, fracture, joint dislocation, soft tissue bruising and laceration)
• Assessment of mental state (e.g. abbreviated mental status examination of the elderly
• If the patient does not have evidence of acute illness or injury, screening for neurological and musculoskeletal disorders with the ‘get up and go’ test: to ask the patient to stand up from a chair without using the arms, walk several paces and return: can this be done without difficulty or unsteadiness?
• American Geriatrics Society, British Geriatrics Society and American Academy of Ortho-paedic Surgeons Panel on Falls Prevention. Guideline for the prevention of falls in older persons. J Am Geriatrics Soc 2001; 49: 664–72.
• Kannus P. Prevention of falls and consequent injuries in elderly people. Lancet 2005; 366: 1885–93.
• Parker M, Johansen A. Hip fracture. BMJ 2006; 333: 27–30.
• Falls and ‘off legs’