Clinical Case Database / Category: Clinical Care

Management of the older patient attending hospital with a fall

Publication details

James D. Crane, Dr. Finbarr C. Martin
Foundation Years Journal, volume 2, issue 6, p.260 (123Doc Education, London, July 2008)

Abstract

Mrs. Turner is an 82-year-old woman who has been brought in by ambulance to the Emergency Department of her local district general hospital, accompanied by her daughter. Her daughter called by in the morning as planned and, having let herself in when there was no answer to the doorbell, found her lying on the landing outside her bedroom. The ambulance crew report that she had been incontinent of urine. Her GCS was noted to be 15/15. She complained of pain in the upper thigh but denied any head or neck injury. On arrival in the MAU she had her baseline observations recorded by nursing staff: she is alert, her pulse is 55 bpm, BP 140/85, respiratory rate 16, oxygen saturation 99%, temperature 37.8°C. A urine dipstick shows leukocytes , ketones but is otherwise clear. X-rays ordered by the Emergency Department staff showed a left pubic ramus fracture, but the hips were OK. Analgesia was given promptly

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Authors

James D. Crane

Horton General Hospital, Banbury
Part of Oxford Radcliffe Hospitals NHS Trust
Headley Way
Headington
Oxford

Dr. Finbarr C. Martin (Corresponding author)

Consultant Physician
Guys and St Thomas’ NHS Foundation Trust
Westminster Bridge Road
London
SE1 7EH

References

1. National Institute for Clinical Excellence. 2004. Clinical Practice Guideline for the Assessment and Prevention of Falls in Older People. Royal College of Nursing. London: National Institute for Clinical Excellence.
2. Brignole M. Distinguishing syncopal from non-syncopal causes of fall in older people, Age and Ageing 2006 35–S2:ii46–ii50.
3. Rubenstein LZ. Falls in older people: Epidemiology, risk factors and strategies for prevention, Age and Ageing 2006 35–S2:ii37–ii41.
4. Manchester D, Wollacott M, Zederbauer-Hilton N, Marin O. Visual, vestibular and somatosensory contributions to balance control in the older adult, Journal of Gerentology 1989 44(4):M118–M127.
5. Hartikainen S, Lonnroos E, Louhivuori K. Medication as a risk factor for falls: Critical systematic review. Journals of Gerontology: Medical Sciences 2007 62A (10):1172–1181.
6. Harwood RH, Foss AJ, Osborn F, Gregson RM, Zaman A, Masud T. Falls and health status in elderly women following first eye cataract surgery: A randomised controlled trial. The British Journal of Ophthalmology 2005 89(1):53–59.
7. Hodkinson HM. Evaluation of a mental test score for assessment of mental impairment in the elderly. Age and Ageing 1972 1:233–236.
8. Shaw FE. Falls in cognitive impairment and dementia. Clinics in Geriatric Medicine 2002 18:159–173.
9. Shumway-Cook A, Brauer S, W oollacott M. Predicting the probability for falls in community-dwelling older adults using the timed up and go test. Physical Therapy 2000 80(9):896–903.
10. Lord SR, Lloyd DG, Li SK. Sensori-motor functioning, gait patterns and falls in community dwelling women. Age and Ageing 1995 25:292–299.
11. Task Force on Syncope, European Society of Cardiology. Part 1. The initial evaluation of patients with syncope. Europace 2001 3:253–260 doi:10.1053/ eupc.2001.0190, available online at http://www.idealibrary.com
12. Parry SW , Frearson R, Steen N, Newton J, Tryambake P, K enny RA. Evidence-based algorithms and the management of falls and syncope presenting to acute medical services. Clinical Medicine 2008 8 (2):157–162.
13. Friedman SM, Munoz B, West SK, Rudin GS, Fried LP. Falls and fear of falling: Which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention. Journal of the American Geriatrics Society 2002 50(8):1329–1335.
14. Chang JT, Morton SC, Rubenstein LZ, Mojica WA, Maglione M, Suttorp MJ, Roth EA, Shekelle PG. Interventions for the prevention of falls in older adults: Systematic review and meta-analysis of randomised clinical trials. British Medical Journal 2004 328:680–684.
15. Gillespie LD, Gillespie WJ, R obertson MC, Lamb SE, Cumming RG, R owe BH. Interventions for preventing falls in elderly people. Cochrane Database Systematic Reviews 2003 (4):doi:10.1002/14651858.CD000340.
16. Bischoff-Ferrari HA, et al. Effect of vitamin D on falls: A meta analysis. The Journal of the American Medical Association 2004 291(16):1999–2006.
17. Royal College of P hysicians Clinical Effectiveness and Evaluation Unit. National Clinical Audit of Falls and Bone Health in Older P eople, 2007. Available from: www.rcplondon.ac.uk/clinical-standards/ceeu/Currentwork/Pages/Falls and-Bone-Health-in-Older-People.aspx
18. Matkovic V, et al. Timing of peak bone mass in Caucasian females and its implications for the prevention of osteoporosis. Inference from a cross-sectional model. The Journal of Clinical Investigation 1994 93(2):799–808.
19. Compston J. Osteoporosis inOxford Textbook of Medicine, 4th edn, Warrell DA, Cox TM, Firth JD (eds). Oxford University Press, Oxford, UK, 2005.
20. Marshall D, Johnell O, W edel H. Meta-analysis of how well measures of bone mineral predict fractures. British Medical Journal 1996 312: 1254–1259.
21. Järvinen TL, Sievänen H, Khan KM, Heinonen A, Kannus P. Shifting the focus in fracture prevention from osteoporosis to falls. British Medical Journal. 19 January 2008 336:124–126.
22. NICE. TA87 Osteoporosis—secondary prevention: Quick reference guide. 2005 www.nice.org.uk
23. Wells G, Cranney A, Peterson J, Boucher M, Shea B, R obinson V, et al. Alendronate for the primary and secondary prevention of osteoporotic fractures in post-menopausal women.Cochrane Database of Systematic Reviews 2008 Issue 1. Art. No.: CD001155: DOI: 10.1002/14651858.CD001155.pub2.
24. Tang BMP, Eslick GD, Nowson C, Smith CAB. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: A meta-analysis. Lancet 2007 370(9588):657–666.
25. Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and non-fatal falls among older adults. Injury Prevention 2006 12: 290–295.

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