Fall History And Examination

Falls History:

Onset of Falls:

• When did the patient experience the first fall?

Frequency:

• How many falls in the past 1 year?

Location:

• Where did the falls occur?

Timing:

• Is there a specific time of day when falls tend to happen?

Pre-Fall:

• Are there any specific triggers that lead to falls?

• Any chest pain prior to the fall?

• Any dizziness/ breathlessness?

During the Fall:

• Any incontinence?

• Any loss of consciousness?

• Did the patient injure him/herself?

• Which part of the body did the patient land on?

Post Fall:

• What happened after the fall?

• Was the patient able to stand up his/herself after the fall?

• How long was the patient on the ground?

• Was the patient able to ambulate afterwards?

• Was the patient confused after the event?

• Was there any weakness/ difficulty in speech after the event?

Assistive Devices:

• Does the patient use any assistive devices like a walking stick or walking frame?

• Is the patient using the device regularly or ad hoc/ PRN ?

Home Environment:

• Is the home environment safe to prevent falls?

Fear of Falling:

• Is the patient fearful of falling again?

Previous Assessments:

• Has the patient had a falls assessment in the past?
  Ensure to thoroughly investigate these aspects to gain a comprehensive understanding of the patient's falls history.

Social History:

• Any alcohol use?

• Social set-up : Is the patient alone at home? Was there someone else at home to witness the fall? If not, is there someone else who is able to provide more information - eg. Community Nurse, a neighbour who checks in regularly, or a Medical Social Worker

Medication Review:

Are there any medications that the patient is taking that increases risk of falls?

Eg. of medications that can may increase the risk of falls

• OHGAs/Insulin- Look for hypoglycemia

• Antihypertensives - Look for hypotension

• Benzodiazepines- Sedation

• Antihistamines( Especially 1st generation)- Sedation

Falls Examination

• Postural Blood Pressure

• Assess hearing and vision

• Look for bunions, callouses, arthritis

• Neurological examination

  • Looking for weakness

  • Any parkinsonism

  • Any sensory neuropathies

  • Assess gait

  • Assess balance