Management (general and specific)

Any disease process that may have contributed to the patient falling (eg. Infection) or injury resulting from the episode (eg. a fractured neck of femur) will of course need to be addressed in their own way, and may require specialist referral as appropriate.

As we have covered, elderly patients (especially though osteoporosis) are susceptible to fractures from even low-impact injuries which is why analgesia should be a priority early on. RCEM (2018) have published audits stressing the need to provide adequate pain relief for patients with a fractured neck of femur – this may be achieved via a fascia iliac block. When radiological tests are pending, other forms of analgesia can be administered in the interim.

Rhabdomyolysis as a consequence of a long lie might be evident as an acute kidney injury with a marked rise in creatine kinase (CK) (Wongrakpanich et al, 2018), and may be treated with vigorous hydration – however this must be done cautiously in patients who might be prone to fluid overload (eg. those with an impaired ejection fraction). 

Additional considerations for patents who have suffered a falling episode would be in addressing the patient’s social circumstances, ability to carry out activities of daily living safely and measures to prevent further recurrence of falls.

Discharging a patient back to an unsafe environment is unacceptable, and so it might become necessary for the patient to be admitted to hospital so that services can be put in place to support the patient. The prevention of falls is supported by services such as the following:

• Care packages – for patients who require additional help with activities of daily living
• Physiotherapists – can support patients with an unstable gait
• Occupational therapists – strategies to prevent falls at home including modifications to the home environment
• Medication reviews – to address any offending medications which might contribute to falls (eg. antihypertensives) or which otherwise pose a threat to the patient’s wellbeing if they are deemed to be at increased risk of falls (eg. anticoagulants).

Learning Bite:

a multidisciplinary approach to ensuring patients can return home safely is worth remembering, and may require hospital admission to facilitate.