Falls

Falls Referrals:

 

This clinic is appropriate for the following types of patients:

Age over 60.

Patients with 2 or more falls in the past year.

Unexplained falls

BPPV-like symptoms if not settling or other unexpected symptoms

Falls associated with dizziness or blackouts (Please discuss DVLA guidelines   for unexplained/unprovoked loss of consciousness if appropriate)  http://www.dft.gov.uk/dvla/medical/ataglance.aspx 

 

 

It is NOT appropriate for:

            Single fall

            Simple explained fall

Referral on to physiotherapy only (please refer via community physio services)

 

 

Things to consider prior to referral:

 

·         Falls may be due to undiagnosed problems:          

o   Neurological

o   ENT/Vestibular

o   Polypharmacy

o   Cardiovascular

o   Consider Syncope:

o   http://rms.kernowccg.nhs.uk/rms/primary_care_clinical_referral_criteria/rms/primary_care_clinical_referral_criteria/cardiology/syncope

 

                        ……………..treat and refer as appropriate

 

Please include the following information in your letter:

 

·         Initial Investigations -

o   Lying and Standing BP – if symptomatic drop of > 20mmHg then consider stopping/reducing drugs which reduce BP (see below)

o   If BPPV suspected consider Hallpike +/- Epley’s if appropriate

o   Bloods: FBC (symptomatic anaemia), U&Es, HbA1c if diabetic

 

·         Drug Review

o   Polypharmacy leads to falls!!  Increased risk if >4 medications.

o   Drugs which lead to falls –TCAs (amitriptyline), antipsychotics (prochlorperazine), benzodiazepines, anticholinergics (oxybutynin), opiates

o   Drugs which may cause orthostatic hypotension - Diuretics, CCBs, ACEi, A2RBs, alpha blockers