1. Falls and Balance Clinic
Assessment forms for the clinic
These forms are designed to be printed onto blank medical record pages. Other clinics, doctors, and physiotherapists are free to use these forms, however you should acknowledge authorship by the Falls and Balance Clinic – Kingston Centre, and any other authors.
It is often difficult to take and record a falls history. This form has been developed to help direct additional questions as needed and to record information. It is based on a Falls patient questionnaire devised by Eastern Health Falls and Balance Clinic which we have adapted.
This form was developed as we decided a home visit where a falls history is taken (Falls history form), a medication review, cognitive, visual, and safety in the home assessments would streamline and direct a clinic assessment.
This form was developed to record the examination swiftly and then direct diagnosis, investigation, and management.
This tool is used because depression effects gait parameters and even low scores on the GDS are predictive of falls. This form was developed by Dr. Stephanie Ward, geriatrician at Kingston Centre.
Care plan phrases
This document was developed to streamline writing care plans to the patient following a clinic visit. These phrases can be put onto the computer such that they will auto-populate the care plan.
The care plan form
We have noted significant issues of compliance by the patient and the GP with our recommendations so this is plan is written is a specific fashion. There should be up to 3-4 problems, maximum of five as not to overwhelm the patients. There can be as many recommendations as necessary. A copy of this is sent to the GP as well as the patient.
- Here is a letter to send to an optometrist to assess a patient’s depth perception and contrast sensitivity.
- This is a letter about a vitamin D result which can be modified depending on the level.
- Here is a proforma letter about a 24hr BP monitor result.
2. Ward assessment tools
3. GP quick screen and GP aide memoire for falls management
- GP quick screen: this guide was developed a quick screen and management tool for patients being referred to a falls clinic to aid GP management before the patient can be seen in a clinic.
- GP aide memoire for falls management.
This letter is designed to written from a physiotherapist to a GP to prompt the GPs to address a falls issue that the physio has identified. The letter was developed in conjunction with the Aged Care Steering Committee of the Dandenong Casey division of General Practice to be acceptable to GPs.
To use the letter you need to delete the sections that are not relevant to the patient.
5. Falls resources
- Modified Tandem balance diagram – Modified Sharpened Rhomberg
- Calcium requirements for the elderly
- Sleep hygiene recommendations when weaning benzodiazepines: http://www.viha.ca/NR/rdonlyres/EFB87684-E9A4-4FF3-9D59-174C0DCC5234/0/sleep_hygiene.pdf
- Plan for reduction of benzodiazepines – patient information: http://www.nps.org.au/__data/assets/pdf_file/0015/211272/reduction_plan_sleeping_tablets.pdf
- Hip protector order form: http://monashhealth.org/about-us/monash-health-sites/hospitals-and-major-sites/kingston-centre/monarc/registrar-resources-falls/
- Footwear guide
- Recommended frames one for indoor and one for outdoor use.
- Clinical Guidelines: http://anzhfr.org/2012-06-20-13-09-09/clinical-guidelines
- Osteoporosis Australia, Research and Position Papers: http://www.osteoporosis.org.au/health-professionals/research-position-papers/
- Neuro-opthalmology: This is a web site with a large amount of neuro-opthalmology videos showing many types of nystagmus: http://novel.utah.edu/Wray/stability_disorders.php
- Multilingual cue cards to aid communication in multiple settings. You can create a communication board for the patient including basic communication, medical investigations and procedures, people in the hospital, and descriptors: http://www.easternhealth.org.au/services/cuecards/default.aspx
- Medicines and Falls in Hospital: http://www.bgs.org.uk/campaigns/fallsafe/Falls_drug_guide.pdf
- These are interpretations of history, examination and physiotherapy findings developed by Prue Morgan, a previous physiotherapist in the clinic.
6. Reference articles
- Horak FB, Wrisley DM, Frank J. The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits. Phys Ther. 2009,89:484–498 (doi:10.2522/ptj.20080071).
- Franchignoni F, Horak F, Godi M, Nardone A, Giordano A. USING PSYCHOMETRIC TECHNIQUES TO IMPROVE THE BALANCE EVALUATION SYSTEMS TEST: THE MINI-BESTEST. J Rehabil Med. 2010,42:316–324 (doi:10.2340/16501977-0537).
- Danoudis M. HOW DO WE BALANCE AND HOW TO MEASURE IT?
- Brignole M, Hamdan MH. New Concepts in the Assessment of Syncope.Journal of the American College of Cardiology. 2012,59(18):1583-91 (doi:10.1016/j.jacc.2011.11.056).
- Snijders AH, van de Warrenburg BP, Giladi N, Bloem BR. Neurological gait disorders in elderly people: clinical approach and classification. Lancet Neurol. 2007,6:63–74 (doi:10.1016/S1474-4422(06)70678-0).
- Kuo CH, Pang L, Chang R. Vertigo: Part 1 – Assessment in general practice. Australian Family Physician, May 2008, 37, 5:341 (http://www.racgp.org.au/afp/200805/200805kuo.pdf).
- Kuo CH, Pang L, Chang R. Vertigo: Part 2 – management in general practice. Australian Family Physician, Jun 2008, 37, 6:409 (http://www.racgp.org.au/afpbackissues/2008/200806/200806kuo.pdf).
- Paine M. Dealing with dizziness. Aust Prescr 2005,28:94-7 (http://www.australianprescriber.com/magazine/28/4/article/700.pdf).
Impaired blood pressure regulation
- Luciano GL, Brennan MJ, Rothberg MB. Postprandial hypotension. Am J Med. 2010,123:281.e1-e6 (doi:10.1016/j.amjmed.2009.06.026).
- Hackman KL, Gagnon C, Briscoe RK, Lam S, Anpalahan M, Ebeling PR. Efficacy and safety of oral continuous low-dose versus short-term high-dose vitamin D: a prospective randomised trial conducted in a clinical setting.MJA. 2010,192:686–689 (https://www.mja.com.au/system/files/issues/192_12_210610/hac11145_fm.pdf).
- Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, and Reginster J-Y (on behalf of the Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis and the Committee of Scientific Advisors of the International Osteoporosis Foundation). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2013,24(1):23-57 (doi: 10.1007/s00198-012-2074-y).
Role of cognition
- Muir SW, Gopaul K, Montero Odasso MM. The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis. Age and Ageing. 2012,41: 299–308 (doi:10.1093/ageing/afs012).
- Harwood RH, Foss AJE, Osborn F, Gregson RM, Zaman A, Masud T. Falls and health status in elderly women following first eye cataract surgery: arandomised controlled trial. Br J Ophthalmol. 2005,89:53-59 (doi:10.1136/bjo.2004.049478).
Depression and gait
- Brandler TC, Wang C, Oh-Park M, Holtzer R, Verghese J. Depressive symptoms and gait dysfunction in the elderly. Am J Geriatr Psychiatry. 2012,20(5):425-32 (doi:10.1097/JGP.0b013e31821181c6).
- Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JC. Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc. 2008,56(12):2234-43 (doi:10.1111/j.1532-5415.2008.02014.x).
- Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society. Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011,59(1):148-57 (doi:10.1111/j.1532-5415.2010.03234.x).
- Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE. Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD007146. (doi:10.1002/14651858.CD007146.pub3).
- Cameron ID, Gillespie LD, Robertson MC, Murray GR, Hill KD, Cumming RG, Kerse N. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.:CD005465 (doi:10.1002/14651858.CD005465.pub3).
- Logan IC, Witham MD. Efficacy of treatments for orthostatic hypotension: a systematic review. Age Ageing. 2012,41(5):587-94 (doi:10.1093/ageing/afs061).
- Robertson D. The pathophysiology and diagnosis of orthostatic hypotension. Clin Auton Res. 2008,18(S1):2-7 (doi:10.1007/s10286-007-1004-0).
- Valbusa F, Labat C, Salvi P, Vivian ME, Hanon O, Benetos A, PARTAGE investigators. Orthostatic hypotension in very old individuals living in nursing homes: the PARTAGE study. J Hypertens. 2012,30(1):53-60 (doi:10.1097/HJH.0b013e32834d3d73).
- Freeman R, Wieling W, Axelrod FB, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011,21(2):69-72 (doi:10.1007/s10286-011-0119-5).
- Gehrking JA, Hines SM, Benrud-Larson LM, Opher-Gehrking TL, Low PA. What is the minimum duration of head-up tilt necessary to detect orthostatic hypotension? Clinical Autonomic Research. 2005,15(2):71-75 (doi:10.1007/s10286-005-0246-y).
- Gibbons CH, Freeman R. Delayed orthostatic hypotension: a frequent cause of orthostatic intolerance. delayed orthostatic hypotension. Neurology. 2006,67(1):28-32 (doi:10.1212/01.wnl.0000223828.28215.0b).
- The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC). Guidelines for the diagnosis and management of syncope (version 2009). European Heart Journal. 2009,30:2631–2671 (doi:10.1093/eurheartj/ehp298).
Lumbar Spinal Canal Stenosis
- Siebert E, Prüss H, Klingebiel R, Failli V, Einhäupl KM, Schwab JM. Lumbar spinal stenosis: syndrome, diagnostics and treatment. Nature Reviews Neurology. 2009,5:392-403 (doi:10.1038/nrneurol.2009.90).
- NASS Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care – Diagnosis and Treatment of Degenerative Lumbar Spinal Stenosis.
- DeMott TK, Richardson JK, Thies SB, Ashton-Miller JA. Falls and gait characteristics among older persons with peripheral neuropathy. Am J Phys Med Rehabil. 2007,86(2):125-32 (http://www.ncbi.nlm.nih.gov/pubmed/17251694).