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Aug 3, 2023 · This fall history taking guide provides a structured framework for taking a history from a patient following a fall in an OSCE setting, including an examiner checklist.
- Robert Rowley
assessment and prevention of falls in older people. It extends and replaces ‘Falls: assessment and prevention of falls in older people’ (NICE clinical guideline 21; 2004), by including additional recommendations about preventing falls in people admitted to hospital (inpatients).
Falls are a common, but often overlooked, cause of injury. Around 1 in 3 adults over 65 and half of people over 80 will have at least one fall a year. Most falls do not result in serious injury.
All patient fall events, treatment plans and revised interventions are to be documented in the patient health record. Complete the Incident Information Management System (IIMS) notification. For further falls information and resources which include flyers with relevant messages for patients families and carers go to:
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- Background
- History of Presenting Complaint
- Social History
- Medication Review
- Investigations
- Differential Diagnosis
- Management
- References
Those over the age of 65 have the highest risk of falling with 30% of those over 65 and 50% of those over 80 falling at least once a year.¹ Falls can have a profoundly negative impact on the quality of life of the elderly and their carers. Physical distress, pain and injury are also associated with loss of confidence and independence. This negative...
A detailed historyis essential in determining the cause of falls. The table below highlights key information that should be gathered when taking a history. Be cautious in cases where the patient is unable to recall events clearly, as this may indicate new confusion associated with a head injury.
Alcohol intakeSupport at home – friends/family and carersMobility – use of mobility aids and when (e.g. zimmer frame downstairs only)Most medications have side effectswhich can increase the likelihood of falls. Polypharmacy itself is a risk factor for falls. It is good practice to review medications and de-prescribe those which are no-longer indicated. Examples of medications that increase the risk of falls: 1. Beta-blockers (bradycardia) 2. Diabetic medications (hypoglycaemia) ...
Investigationsare based on your history and examination but could include some of those mentioned below.
The differential diagnosis of falls is very broad. It is important to determine whether the patient has suffered a transient loss of consciousness or a simple mechanical fall. Some possible causes of falls are shown in the table below.
Once transient loss of consciousness has been ruled out, it is important to complete a full falls risk assessment. This is indicated in order to identify any causative features especially as older people are likely to have multiple co-existing risk factors. Although priority should be to treat any underlying medical cause (e.g. pacemaker if complet...
Falls in older people: assessing risk and prevention. Clinical guideline [CG161]. Published date:June 2013. Available from: [LINK]
History. As with most of medicine – and geratology particular – history plays an important factor when performing an assessment of a patient who has fallen. The structure below is particularly important in the context of falls: Before the fall. Any pre-syncopal symptoms e.g. feeling dizzy, light-headed, palpitations? What were they doing?
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Actions to take following a fall. If a patient experiences a fall in any in patient setting then the following interventions should be followed. 1. Carry out clinical assessment to check for injury and illness immediately. 2. Undertake clinical observations. In in-patient areas this must include BP, temperature, SATS.
