Falls, Falls Risk, Poor Balance and Dizziness
Adult

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Emergency Referrals

Useful Management Information

Refer to local HealthPathways or local guidelines
A history of falls in the past year is the single most important risk factor for falls and is a predictor for further falls.
Older people reporting a fall or considered at risk of falling should be observed for balance and gait deficits. They should be considered for interventions that improve strength and balance.
Consider referral to clinical pharmacist for Home Medical Medicines Review if evidence of polypharmacy.
Consider referral to specialist falls clinic (if available) if patient has suffered multiple falls with no cause found.
Depending on specialist availability, patients with falls can be referred to either general medicine or geriatric medicine. In the setting of multiple geriatric syndromes, referral to geriatric medicine may be preferred
Evidence for fall prevention strategies:
exercise
high dose vitamin D
medication withdrawal (particularly antidepressants, antipsychotics and benzodiazepines)
occupational therapy home visit
restricted multifocal spectacle use
expedited cataract surgery (where required)
podiatry assessment and intervention
multifactorial assessment with targeted interventions (including referral to physiotherapist, occupational therapist and/or dietitian as appropriate).
Clinician Resources
The following links to cognitive assessment tools may be useful:
Dementia Australia Cognitive screening and assessment
QHEPS Cognitive impairment screening toolkit
GP assessment of cognition (GPCOG) tool
IHPA Standardised Mini-Mental State Examination (SMME)
Rowland Universal Dementia Assessment Scale (RUDAS)
Kimberley Indigenous Cognitive Assessment (KICA)

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	Two or more falls in the previous month
Category 2 (appointment within 90 calendar days)	Two or more falls in previous 12 months Falls as part of an overall decline in physical, social or psychological function
Category 3 (appointment within 365 calendar days)	No category 3 criteria
If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.) Please note that your referral may not be accepted or may be redirected to another service

Standard Referral Information

Reason for request

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can't order, or the patient can't afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
All conservative options that have been pursued unsuccessfully prior to referral
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

Willingness to have surgery (where surgery is a likely intervention)
Choice to be treated as a public or private patient
Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Essential Referral Information

Relevant medical history, comorbidities and medications (including an assessment of adherence)
Number of falls in the previous 12 months
Assessment of cognitive function (MMSE, MOCA or other validated tool) in patients ≥ 65 years of age
FBC & ELFTs
MSU resultsM/C/S
Bone mineral densitometry report, vitamin D assay (if performed)
Results of any therapeutic drug monitoring performed within three months of referral

If a specific test result cannot be obtained due to access, financial, religious, cultural or consent reasons a clinical override may be requested. This reason must be clearly articulated in the body of the referral.

Additional Referral Information

Existing psychosocial issues and supports (family, carers, home services, etc)
Copies of discharge summaries and outpatient letters relating to hospitalisations for falls, or visits to other private specialists, or home assessments for falls risk, if available
Bone Mineral Densitometry report if available
Home Medicines Review report if available
Nutritional status

Send Referrals To

Smart Referrals

Preferred Method
About Smart Referrals

Secure Web Transfer

Send to: Gold Coast Adult Community Health QHealth

Internal Referrals

Not accepted

Fax

07 5687 4497

Post

Central Intake Unit
Robina Health Precinct
Level 4, 2 Campus Crescent
Robina QLD 4226

Enquiries

07 5635 6262

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Dr Arif Alam

Medical Director Falls and Balance Clinic, Cognitive Disorders Service, Geriatric Medicine

Facilities

Robina Health Precinct

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Falls, Falls Risk, Poor Balance and DizzinessAdult