By the end of postgraduate training, using a patient-centred approach and appropriate selectivity, a resident, considering the patient’s cultural and gender contexts, will be able to...
Key Feature 6: In patients at risk for disability (ex: those who do manual labour, the elderly, those with mental illness), recommend primary prevention strategies (ex: exercises, braces, counselling, work modification).
Skill: Clinical Reasoning, Patient Centered
Recently, I had a really long post on dementia and mentioned that part of the management of these patients is ongoing cognitive and functional assessment, and screening for the many complications that are the sequelae of the decline. Psychiatric conditions such as dementia are indeed one of the reasons to assess fall risk in the elderly, and there are many others. My differential for etiologies underlying a fall (which are conversely risk factors for a patient to sustain a fall) is as follows:
My approach to evaluate and manage patients who have fallen is derived from the LMCC approach to falls, which includes the following steps:
Although a few conditions require absolute bedrest (ex: unstable fractures and certain critical illnesses), most medical conditions do not necessitate immobility. Activity orders for bed rest should be avoided unless absolutely medically required. Staff should attempt to get patients out of bed to a chair with meals, which also decreases risk of aspiration and, when possible, encourage patients to walk several times daily.
Patients who have difficulty ambulating on their own or who pose a significant fall risk may need supervision by trained staff (ex: physical therapy) or referral to a specialized mobility program. Increased activity during hospitalization can mitigate functional decline so that patients can transition optimally outside the hospital setting