Inpatient physiotherapists can play a crucial role in preventing falls in older people, says Louise McGregor.
The inpatient physiotherapist’s role in multifactorial falls risk assessments may include:
- identifying falls history
- assessing gait, balance and strength
- assessing functional ability and fears related to falling
- assessing visual impairment
- taking lying and standing blood pressure (BP)
- assessing bone health (via the Q factor or FRAX tools)
- Louise McGregor is the chair of Agile, the CSP professional network for physiotherapists working with older people
Bedside vision check: practice points
- Ask the patient when they last had a sight test (these should be conducted annually). Does the patient wear glasses? Are the lenses up-to-date? What are the glasses for? Do they have an eye condition, such as glaucoma, and, if so, are they using a prescribed treatment?
- Check distance vision: Can the patient see the television clearly? Show an image from about two metres away. If they have distance glasses, they should use them.
- Check near vision: Can they see to read newspaper print or medicine labels? Show them a card with an image in a comfortable reading position. If they have reading glasses, they should wear them.
- Check peripheral vision: Sit face to face with the patient. Ask them to keep looking at your face during the test. Raise your right hand to the 2 o’clock position (towards the edge of your field of vision) and wriggle your fingers. Ask: ‘Can you see my fingers moving?’ If you can, so should they.Repeat the above steps, holding your hand at 4 o’clock.Change to your left hand and test at 8 o’clock and 10 o’clock.
- Check eye movements: Ideally, sit face to face with the patient, knees nearly touching. Ask, ‘Do you ever get double vision/see two of things?’ Are their eyes not pointing straight ahead, or jiggling? Move a pen forward and back, left and right in front of their eyes. Do their eyes move together, following the pen all the way across and up and down? Source: FFFAP.
Taking blood pressure (BP)
Are you going to need assistance to stand the patient up and simultaneously record his or her BP?
Use a manual sphygmomanometer if possible and do so without fail if the automatic machine fails to record:
- Explain procedure to the patient.
- The first BP should be taken after the patient has been lying down for at least five minutes.
- The second BP should be taken after standing in the first minute.
- A third BP should be taken after the patient has been standing for three and a half minutes. This recording can be repeated if the pressure is still falling.
- Symptoms of dizziness, light-headedness, vagueness, pallor, visual disturbance, feelings of weakness and palpitations should be documented.
- A positive result is: (a)a drop in systolic blood pressure of 20mmHg or more (with or without symptoms) (b) a drop to below 90mmhg on standing, even if the drop is less than 20mmHg (with or without symptoms) (c) a drop in diastolic blood pressure of 10mmhg with symptoms (although clinically much less significant than a drop in systolic blood pressure).
- Advise the patient of the results and if the result is positive, inform the medical and nursing team. Take immediate action to prevent falls and or unsteadiness. In the case of positive results, repeat regularly until resolved.
- If symptoms change, repeat the test. Source: FFFAP
AuthorLouise McGregor, Chair of Agile, CSP professional network for physiotherapists working with older people
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