Stand Near, Without Falling In


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FALL RISK ASSESSMENT

Sometimes drop attacks happen because of knee or hip instability, or because the person keeps tripped over, although usually in these cases the person DOES remember the fall, often with a memory of the whole thing happening in slow motion. Injuries are part and parcel of drop attacks. These can be as bad as broken bones or teeth, but more serious or life threatening injuries are not seen with functional drop attacks even in people having many attacks a day. This is different to epilepsy or even faints where serious injury does sometimes sadly happen.


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This is something to do with the nature of drop attacks not relating to a true loss of consciousness in which the body is completely unprotected. This explains why people with drop attacks tend to crumple rather than topple, and sometimes but not always are able to avoid furniture and other obstacles when falling. For information in general about how and why functional symptoms happen look on these pages.

But in other people its possible to see a pattern that fits quite well in to those seen in other functional disorders. Some evidence for this includes the following. For an example see the story by Mary on this website. Although these may be just described as falls, its often the case that the person feels a slight weakness and the next thing they know they are on the ground having fallen.

In some people this is a clue that dissociation is the reason for the drop attack in the first place. This is an example of a sequence of events that can lead to functional drop attacks. The person suffers a simple trip or fall, or faint — but gets a fright or shock which sets up a sensitivity to falls in the future. As with all functional symptoms and disorders, drop attacks are genuine and are not caused by the person deliberately falling. The person with drop attacks develops, naturally, a fear of further falls which in itself appears to make falls generally more likely.

Its not that the person is frightened about falling all the time, but worrying about falls and the consequences of falls seems to make drop attacks more likely to happen, at least in some people. Having the fall is horrible but afterwards they feel that they are much less likely to have another one that day or that week. As with all functional symptoms and disorders, understanding the nature of the diagnosis is an important first step.

Its bad enough having functional drop attacks without also being worried that you might have epilepsy or a heart condition. Worrying about those things as well is likely to make functional drop attacks worse. Understanding that drop attacks are a very typical clinical problem which an experienced doctor can immediately recognise, and that actually very little else in medicine looks or sounds anything like them can be a good start.

Most people with drop attacks have no warning symptoms, or if they did then that was only in the first few attacks. If you do get some warning symptoms, even if they only last for a few seconds then this is something that you may be able to lengthen using distraction techniques. This is the same kind of treatment advice given for patients with dissociative non-epileptic attacks,. Are there certain situations when drop attacks happen? A minority of patients report only having drop attacks when outside the house, in the same way that people with panic attacks tend to have attacks only when away from the security of their home.

Assessment and Management of Fall Risk in Primary Care Settings

As with dissociative attacks , sometimes although the patient doesn't experience any warning symptoms, those around them like friends and family do sometimes notice some changes just before. These include 'going quiet' or looking 'spaced out', with a 'glazed' expression or as if they are 'not there'. If your friends and family can spot these kinds of dissociative symptoms , ask them to tell you as it may help you recognise the feeling of dissociation that you are looking for.

It sounds a bit weird but in some cases it seems that when people dissociate, they also dissociate from the feeling of being spaced out when it happens! So they do need a bit of help learning to recognise that feeling. In the majority of patients with drop attacks, there are no warning symptoms, they can't be found even when looking hard for them by anyone, the attacks happen anywhere including at home and so it feels as if there is no 'way in' to treatment.

This is often the case even when the patient fully accepts and understands the diagnosis. Treatment approaches worth considering include. Some of the medications described on the treatment - medication page may be worth trying. These include medicines like Amitryptiline and Clomipramine. These are sometimes used to treat another kind of falls called Cataplexy and there are anecdotal reports of success.

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If your drop attacks have come to dominate your life you may be locked in a vicious circle whereby the constant worry of when the next attack will be and what injury you will have next are actually making the problem worse and keeping it going. Talking openly about this with a doctor or psychologist can sometimes be helpful. He does have heart disease as well. His heart was checked out and said to be doing well.

The second number is always lower than it should be.

Assessment and Management of Fall Risk in Primary Care Settings

He is also having anxiety attacks where he breaks down and cries for no reason. Trouble sleeping-staying asleep and sleeps with very odd dreams. Well, if he is having falls, he needs a detailed evaluation to identify as many risk factors and contributors as possible. Getting weaker during hot weather is sometimes related to mild dehydration. This can be made worse during hot weather or dehydration, too. A systolic BP the top number of sounds a bit low to me for someone who is having falls and weakness.

I would also recommend bringing up his anxiety attacks and your other concerns with his usual doctors.


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  • Be careful about treating anxiety with medication, as most anti-anxiety medication does worsen balance. Hi, for the past couple of months I have started falling out of bed on a very regular basis, sometimes up three times in one night, it is now quite painful.

    For the past year I have been suffering with acute pain down my right-hand side, from my neck into my shoulder and through my arm, as though my muscles and inside my bones are on fire. One morning I woke up blind in one eye. I have had steroid injections, electric shock tests, nerve tests to no avail. My hip is also loosening after fifteen years which also causes pain.

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    I currently take co-codamol to control the pain. I am also taking Astor statin 20mg Venlafaxine mg Felopadine 5mg Losartan mg Oxazepam to help me sleep and daily aspirin. I also have a history of fairly severe depression. I already see my Dr far more than I should but any ideas or clues in my description above? Thanks Tony. Honestly, your situation sounds more complicated than most, so good that you are working closely with your doctor. Regarding falling out of bed more frequently, I wonder if you have been able to get any other information on how you are sleeping and are you otherwise moving more than before while asleep?

    Perhaps evaluating and treating your sleep might help with the falls during the night. Otherwise, oxazepam is a benzodiazepine and is associated with increased risk of falls. However, if you have significant anxiety or sleep issues, it can be hard to eliminate this type of medication. Are there any products or plans you might be able to recommend?

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    What do you think are the difficulties that surround this area with the elderly? Such exercises have a good track record in fall prevention, especially if they are combined with exercises that specifically challenge and improve balance. The Otago program combines such strength and balance exercises, and is proven to reduce falls in vulnerable older adults: Videos Illustrating Otago Exercises for Fall Prevention. The difficulty is that such programs require people to practice the exercises three times weekly. So generally I recommend doing a program via a live class or with a physical therapist.

    My 69 year old mother has had three falls in the past year, two while traveling, and one in our house. All three falls had an environmental risk factor present: the first involved a broken entryway platform at a convenient store; the second happened at the top of an escalator; the third involved a throw rug. The most recent changes were a new bp medication that produced headaches, but they treated the headaches with more medication; the foot surgery and non-weight bearing period; and an increase in daytime sleepiness that was treated successfully with melatonin at night.

    Is this the result of slowed reflexes? Also, after the first fall, my mom has been anxious about falling again. Even though she has a lot of possible risk factors, it seems that lack of strength plus the broken step could have been sufficient to have caused the first fall. Is it possible for anxiety or distraction to cause falls? I usually catch myself though because I have good reflexes. Finally, do you have any specific exercise or low-impact strength training programs that you recommend? She is hesitant to do more involved exercises because they can be complicated, or because she says that she avoids getting down on the floor because she struggles to get up easily.

    You have already done a good job identifying several contributing factors, so the question is which can be modified.

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    Exercise would be helpful, it will improve her ability to recover from losing her balance and also is associated with less risk of injury when people do fall. Most people have difficulty motivating to do a program on their own, plus they might be doing the exercises incorrectly.

    source site So being in a group or in physical therapy is a good idea. For instance, squats and deep lunges can be very difficult for older adults to do safely and effectively.

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    Hope this helps and good luck! Thanks for this advice for preventing falls.

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