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Skip to 0 minutes and 9 seconds I’m going to spend some time describing to you what happens in a falls assessment. Some of this is very specific to our own falls service here in Newcastle in the Falls and Syncope Service. But there are elements that are generic across all falls services. So it will give you an idea of what to expect if you come to hospital to be seen, because you’ve had a fall or are at risk of a fall. When you come into a clinic, you’re asked to describe how and where you fell; what you felt and looked like during the fall. You’ll be asked questions about medications that you are taking and things that you might have seen doctors for in the past.

Skip to 0 minutes and 52 seconds You’ll also have an examination to look for any physical reasons why you might have fallen. The next step in the assessment is to look at your vision. After that, there’s some type of assessment of your walking. In the unit here in Newcastle, we perform an assessment called a Timed Up and Go test– or a TUG. This is a very simple way to look at how people walk. We ask people who come to the unit to sit in a chair, and then get up very quickly and walk a distance between two markers laid out on the floor. Lisa Robinson, the physiotherapist who works in our unit, shows how a Timed Up and Go test is performed. OK, are you ready?

Skip to 1 minute and 35 seconds Yes, I am. Go. During the Timed Up and Go test, we’re seeing whether Heather can perform this in 14 seconds or less. If it’s above that, this suggests that Heather might be at risk of further falls. Lisa might go on to look at Heather’s balance and the way she walks– something we call “gait.” We can see here how Lisa does this in more detail using a Tinetti Gait and Balance Assessment. And just take a very small step forwards for me. Great. And what I want you to do now is bring your feet together so that they’re touching. So you can probably feel your feet working a little bit harder. But does that feel OK? Yes, it does. Great.

Skip to 2 minutes and 18 seconds I’m going to make it harder again now by asking you to close your eyes. Does that feel all right? It does. Yes. Great. Open your eyes again. And now just stand with your feet comfortable. Great. For the next test, I’m just going to give you a little push on the front of your chest. What I want you to do is just stand nice and firm for me and don’t let me move you. OK? Yes. Great. I’m going to do that one more time. Great. OK. Next one, I’m just going to ask you to tilt you head back and just look up to the ceiling– but only go as far as your neck feels comfortable. And look forwards again.

Skip to 2 minutes and 57 seconds No dizziness there? No. No? Next one, I’m going to get you just to turn your head side-to-side. Any problems there? No. Brilliant. Next, I’m just going to get you to arch from your lower back, and then just come back to the start for me. Any problems there? No. No? For the next one, I’m just going to ask you to bend down to the floor just as if you were picking something up from the floor. The reason I’ve put the chair here is just in case you feel you need to put your hand on the chair to either lower yourself down or come back up.

Skip to 3 minutes and 32 seconds Did that feel OK? Yes, it did, yes. Good. The next one, I’m just going to ask you to reach up and go on your tip-toes, just as if you were getting something from the back of a high cupboard. Brilliant. You’ve just got two more left to do, now. What I’d like to do next is just to step your feet around in a circle, and then just come back to the front.

Skip to 3 minutes and 58 seconds Great. And the last one– I’ve left the most difficult till the end. I’m just going to get you to stand on one leg for a count of five, and then stand on the other leg. Good.

Skip to 4 minutes and 11 seconds Perfect. And then if you’ll just sit down, that’s the end of the test. The next thing we do in the unit is to perform an assessment of how your blood pressure responds to standing up. OK, Heather. If I can take your arm there. And if you’d pop your fingers– A very common reason why people will fall is that their blood pressure drops when they stand. In our unit, we use special equipment that measures heart rate and blood pressure beat-to-beat. And you can see here how this equipment is put on. And you feel one of these start to inflate on your fingers. In addition to the equipment to measure blood pressure, we also apply electrodes to measure heart rate. Two.

Skip to 4 minutes and 48 seconds One on each shoulder, and one on each hip. And we’re just going to attach the stickers to the wires to monitor your heart. So you can see here now how we view the heart rate and blood pressure. Using this equipment allows us to look for very subtle changes in blood pressure when people stand up, because we’re measuring beat-to-beat. Not all units have equipment as sensitive as this, and it doesn’t necessarily need this type of equipment to be able to measure blood pressure when you stand up. This shows the procedure that we go through when we measure blood pressure in response to standing. We’re going to help you into a standing position. You can see that Heather is lying down flat.

Skip to 5 minutes and 27 seconds She’s been resting for five minutes. And then we ask her to stand with all the equipment in place as quickly as she can. Let’s bring your feet around and come to a stand. We then measure her blood pressure for up to three minutes to see what happens when she stands up. And if you need to sit down you can. Yeah, OK. Thank you. We’re going to watch your blood pressure throughout the test to see what it does. So now you’ve seen how we measure heart rate and blood pressure when people stand up.

Skip to 5 minutes and 56 seconds With the combination of all these different assessments when people come to see us in the clinic, we’re able to get an awful lot of information about their falls risks, and whether there are things that we can do to reduce their risks of falls.

The falls clinic

Most falls clinics will perform the same basic tests. These are based around identifying risk factors, underlying medical causes and protecting the bones.

During this video we will see a timed walking test, a gait and balance assessment, a brief vision test, a lying and standing blood pressure test and an electrocardiogram (ECG) to monitor heart rate.

  • Thinking back to Week 1 and Week 2 can you suggest why each of the tests featured in this video is used in a falls assessment?

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Ageing Well: Why Older People Fall

Newcastle University

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