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      Mary Trafford

      Age: 80 years old female

      Examiner

      Station List
      Patient
      Doctor
      Full Case

      Marking Scheme

      History

      • Ask about mechanism of fall.
      • Ask if any injury /fracture was sustained and if she was able to get herself up.
      • Ask how patient is fairing now
      • Ask about pre-fall symptoms to rule out cardiac involvement- dizziness, chest pain, SOB,
      • Ask if patient can recollect events of fall and if anyone witnessed falls
      • Ask if anything is affecting her mobility- such as arthritis/pain, symptoms of Parkinson’s (Tremors, slow gait), memory issues like dementia, poor vision.
      • Ask about urine symptoms- urinary frequency/incontinence.
      • Ask if she looks frail
      • Ask about Home hazards such as loose rugs or mats, poor lighting, wet surfaces(especially in the bathroom), and loose fittings (such as handrails).
      • Ask about home situation, how patient is coping and if Nurse thinks she may need carers; ask if patient is hoarding (Keeping lots of unnecessary things at home leading to everywhere been jampacked).
      • Ask about feeding (Hypoglycaemia can cause recurrent falls; Tea and Toast syndrome can lead to hyponatraemia which in turn can lead to falls).
      • Ask about alcohol use.
      • Ask if this has affected her mental health of have made her lose confidence.
      • Ask ICE of nurse
      • Give diagnosis of recurrent falls probable due to frailty.

      Explain to your colleague; Sam, thank you for seeing Mrs. Trafford and providing such a thorough assessment. I agree with you that her recurrent falls are likely due to frailty, but there are also other factors that could be contributing, like her multiple medications. Specifically, medications like sertraline indapamide, amitriptyline and omeprazole can affect her sodium levels and may be increasing her risk of falls.

      Would you be comfortable getting some blood tests done for her, including FBC, U+E’s, LFT, and Hba1c? I’ll make sure to raise the forms for you.

      Can she arrange to get anti-fall stockings? If not, I can ask our social prescriber and see if we can arrange this for her.

      Please, ensure she’s reminded to keep her home clear of any loose rugs or obstacles that might cause tripping. Also, I’ll be referring her to the falls clinic so she can be properly assessed by a physiotherapist. In addition, I’ll organize a falls alarm for her, so that if she does fall, she’ll be able to alert emergency services.

      It would also be a good idea for her to get an eye check, just to make sure her vision is still okay, as this can sometimes contribute to falls.Meanwhile, I’ll get her medication reviewed by the pharmacist, and I’d advise that she stops taking the indapamide for now.

      Thanks again for all your hard work with Mrs. Trafford’s care, Sam

      Management

      Management

      • Ask if district nurse is happy to take blood sample- organise bloods for U+ E(Sertraline and Omeprazole can cause hyponatraemia and lead to fall), FBC(Anaemia), Hba1c (Diabetes can cause fall).
      • Patient can also be booked for ECG to rule out any underlying cardiac issues that might contribute to falls (e.g., arrhythmias).
      • Offer to book with pharmacy to tackle polypharmacy issues, meanwhile, you can reduce blood pressure tablets and repeat blood pressure in 1 week time to monitor. For example- Amlodipine from 10 to 5 mg or stopping indapamide totally and leaving patient just on Amlodipine.
      • Offer referral to falls clinic for proper assessment where she will be seen by clinicians and physio for strength and balancing training to boost her confidence.
      • Offer falls alarm/falls bracelet to alert emergency services if patient falls again—this can be gotten from frailty practitioners / social prescribers
      • If you sense patient is at higher risk of falling and she is at danger staying alone,you can offer short respite care/ short admission to nursing home/emergency carers for short care at her house until patient regains confidence –ensurepatient will be happy with this plan
      • Offer occupational health assessment of home situation to remove rugs and carpets that maybe loose and other things that contribute to falls. They could also install railings to help patient
      • If there is change in vision, then send for visual assessment with high street opticians.
      • Safety net-If patient’s condition worsens or if she experiences any further falls,she should contact the GP/ seek urgent medical advice.