Falls assessment

Falls assessment – older people presenting with falls to general practitioners ( GP ) is very common. This review on A4Medicine incorporates the current management in the Primary care of people presenting with falls, it describes the risk factors ( intrinsic and extrinsic ) assessment and general approach to falls. Referral to a multifactorial risk assessment team is recommended as part of an individualized multifactorial intervention. An algorithm produced by the  Centers for Disease Control and Prevention and STEADI-Stopping Elderly Accidents, Deaths & Injuries has been reproduced for user reference

An unexpected event in which participant comes to rest on the ground , floor , or lower level.Falls and fall-related injuries – common problem for older people
 People over 65 and older have the highest risk of falling 
○ 30 % of people older than 65 and
○ 50 % of people older than 80
 Leading cause of death due to unintentional injury in people over 65 in the US Leads to
○ distress
○ pain
○ injury
○ loss of confidence
○ loss of independence and mortality
About 5 % of falls in older people who live in community result in a fracture or hospitilization
95 % of hip fractures happen following a fall
 NHS cost approximately £ 2.3 billion / year ( NICE June 2013 ) Falls are neither purely accidental nor inevitable –> many falls are preventable

Intrinsic causes-Age Female gender Previous h/o falls
 Comorbidities as
○ orthostatic hypotension
○ musculoskeletal disease
 OA , Osteoporosis , Lower back pain
○ visual impairment
 Independent risk factor for falls and fractures
 Other medical conditions as
○ low systolic BP
○ stroke
○ cognitive impairment
○ Parkinson’s disease
○ gait disorder
○ balance disorders ( eg BPPV )
○ other sensory impairments
○ continence problems
○ syncope
 Medications- alone or in combination
particularly
○ benzodiazepines
○ sedative hypnotics
○ anti-depressants
○ anti-hypertensives
○ anti- arrhythmics
○ diuretics
○ anti-convulsants
○ NSAIDs

Extrinsic causes- Any environmental factor that causes
tripping
slipping or
loss of balance 

this includes
rugs
electrical cords
pets
items on floor
 Stairs ( no handrail ) Irregular slippery floor Bathtub Low toilets or chairs Poor lighting Uneven sidewalks Footwear Snow, ice

Simple fall happens as a result of a chronic impairment of cognition , vision , balance or mobility.Collapse- occurs as a result of an acute medical problem such as an acute arrhythmia , TIA or vertigo.Had one or more falls in the last 12 months Differentiate between
Simple fall and Collapse.circumstances in which fall happened how often any symptoms associated with fall as
○ light headedness
○ LOC collateral history if available
○ older people may have amnesia of syncope
○ cognitive deficits effecting recall

At risk of falling-underlying cognitive impairment visual impairment physically frail condition that affects mobility and balance as
○ arthritis
○ diabetes
○ incontinence
○ stroke
○ Parkinson’s disease Polypharmacy
○ psychoactive drugs
○ drugs causing postural hypotension Fear of falling

 Postural hypotension is
 defined as a reduction
 in systolic BP of 
atleast 20 mm Hg or
 in diastolic bp of 
atleast 10 mm Hg within
 3 minutes of standing

Examination- Orthostatic vital signs Distance visual acuity Cardiac examination Gait and balance Musculoskeletal examination of back and lower extremities Neurological examination
○ cognition
○ sensation
○ proprioception
○ muscle bulk , tone , strength , reflexes and range of motion
○ higher neurological function


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