Elderly patients should be asked about their history of falls so that they can undergo specialist assessment, says Alison Wall



I found Dr Alan Begg’s article on the management of stroke very useful (‘New contract helps to optimise care of stroke and TIA patients’, Guidelines in Practice, July 2005).

It highlights the importance of practices keeping up to date registers which link all the relevant agencies involved in the care and management of those who have suffered a stroke.

In our PCT we are trying to develop a seamless pathway for falls in our elderly population. A key problem is the difficulty of setting up practice registers to record falls and the events surrounding the fall.

Older people tend not to report accidents that they have had. This may be for a variety of reasons. Some may feel that healthcare professionals will consider that they are no longer able to live independently.

A falls clinic, however, can identify the key factors that cause falls. We should all routinely ask our older patients about falls so that they can receive the support they need.

I hope that in time the quality and outcomes framework will cover falls. This will encourage practices to develop appropriate referral pathways for those who suffer falls to enable patients to undergo specialist assessment.

Alison Wall,
PEC nurse lead for falls,
Watford and Three Rivers PCT

Guidance on bipolar disorder welcomed

I am pleased that SIGN has published a guideline to aid clinicians in the diagnosis and management of bipolar affective disorder (News, Guidelines in Practice, June 2005). The guideline makes explicit the need for an early diagnosis, and recommends using DSM-IV or ICD-10 coding.

It also emphasises the need to be aware of the instability of the diagnosis during clinical review.This will have implications for updating Read codes and the accuracy of disease registers.

The guideline reinforces the need to be aware of the risks associated with lithium use and recommends a shared care protocol. This can be achieved through effective coordination arrangements with specialist mental health services.

Alternatives to lithium such as carbamazepine and lamotrigine are recommended for prevention of relapses. This is useful as lithium is not tolerated by all patients.

Newer drugs such as antipsychotics and semisodium valproate are recommended for the treatment of acute mania in cases where the mania is associated with dangerous behaviour. The annual review provides the opportunity to identify psychosocial interventions and carry out reproductive health promotion, as the guideline recommends. This will depend, however, on local resources.

Dr Jill Murie,

Guidelines in Practice, August 2005, Volume 8(8)
© 2005 MGP Ltd
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