This clinic is appropriate for the following types of patients:
Age over 60.
Patients with 2 or more falls in the past year.
BPPV-like symptoms if not settling or other unexpected symptoms
Falls associated with dizziness or blackouts (Please discuss DVLA guidelines for unexplained/unprovoked loss of consciousness if appropriate) http://www.dft.gov.uk/dvla/medical/ataglance.aspx
It is NOT appropriate for:
Simple explained fall
Referral on to physiotherapy only (please refer via community physio services)
Things to consider prior to referral:
· Falls may be due to undiagnosed problems:
o Consider Syncope:
……………..treat and refer as appropriate
Please include the following information in your letter:
· Initial Investigations -
o Lying and Standing BP – if symptomatic drop of > 20mmHg then consider stopping/reducing drugs which reduce BP (see below)
o If BPPV suspected consider Hallpike +/- Epley’s if appropriate
o Bloods: FBC (symptomatic anaemia), U&Es, HbA1c if diabetic
· Drug Review
o Polypharmacy leads to falls!! Increased risk if >4 medications.
o Drugs which lead to falls –TCAs (amitriptyline), antipsychotics (prochlorperazine), benzodiazepines, anticholinergics (oxybutynin), opiates
o Drugs which may cause orthostatic hypotension - Diuretics, CCBs, ACEi, A2RBs, alpha blockers