Diagnosis
-H&P:
-Risk Factors: -Patients with a history of recent falls are at highest risk for recurrent falls.
-Med Review for culprit meds. Decrease or D/C psychoactive medications to prevent falls.
-Will evaluate for postural hypotension (orthostatic hypotension), as this can be a contributor to falls, especially after prolonged bed rest.
-Evaluate for dementia
-Basic labs: CBC, CMP, TSH, lipid panel, 25-Hydroxy Vit D.
-Head CT as needed.
-DEXA scan – evaluate & treat osteoporosis.
Treatment
–Fall prevention strategy discussed.
-Vitamin D Supplementation, per USPSTF.
-Exercise or physical therapy for balance, gait, and strength training.
-Wheelchair first, then motorized vehicle (e.g. scooter) if the wheelchair is making a difference.
-Get up and go test:
-Sit to stand test:
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-Consider D/C any anticoagulants?
Head CT
**If a patient has head trauma while on anticoagulant therapy, get a CT immediately to evaluated for ICH or SAH. Imaging is recommended on all anticoagulated patients even those with mild or minor head trauma. Some authorities recommend a 24h observation followed by a 2nd CT head to detect delayed bleeds.