Falls

Rationale

Falls are common and have many possible contributing factors. They can be associated with serious injury. Multifactorial interventions can prevent falls and their sequelae.

Causal Conditions

(list not exhaustive)

1. Medical conditions (e.g., vertigo, gait disturbances, syncope)
2. Psychiatric conditions (e.g., cognitive impairment, substance use disorder)
3. Medications
4. Environmental or behavioural risk factors (e.g., walking surface, choice of footwear)
5. Other contributors (e.g., decreased vision, urinary urgency)

Key Objectives

Given a patient who is at risk of falls, the candidate will identify contributing factors and initiate an appropriate management and prevention plan.

Enabling Objectives

Given a patient at risk of falling, the candidate will

1. list and interpret critical clinical findings, including those based on
   1. a description of recent and previous falls;
   2. a medical history for risk factors (e.g., medical conditions, medication history, substance use disorder);
   3. environmental hazards; and
   4. a complete physical and functional evaluation;
2. list and interpret relevant investigations, and
3. construct an effective initial management plan, including
   1. managing acute and chronic illness with particular attention to a review of medications;
   2. suggesting specific interventions for preventing further falls (e.g., balance and gait training, muscle strengthening exercises);
   3. suggesting appropriate home safety interventions (e.g., removing environmental hazards, grab bars, emergency response systems);
   4. appropriate consultation, including with medical specialists and other health professionals (e.g., physiotherapist and occupational therapist, social worker, pharmacist); and
   5. referral to an addiction rehabilitation service if appropriate (e.g., addictions counsellor, addictions rehabilitation program).