Falls

From Ganfyd

Caused by gravity. For further detail see general relativity

Assessment as follows will miss little that is treatable I HATE FALLING[1] Inflammation of joints (or joint deformity) Hypotension (orthostatic or baroreceptive) Auditory and visual abnormalities Tremor (eg Parkinsonism, Alcohol withdrawal) Equilibrium (balance) problem Foot problems Arrythmia, heart block, valvular disease, cardio-inhibitory syncope Leg-length discrepancy Illness (eg new Myocardial Infarction, Stroke, Infection) Nutrition Gait disturbance (ah you did check patient could walk !)

Definition

A sudden, unintentional change in position causing one to land on a lower level; unintentionally coming to land at a lower level, on an object, the fall, or the ground. Tinetti et al 1997

Context

More common in the young and elderly. In the elderly:

• 550,000 home/leisure accidents to 65+ age group presenting to A&E in UK
• Up to 30% of 65+ group fall/year
• Up to 50% of 80+ group fall/year

Pathology

• Trauma secondary to deceleration injury or environmental hazards
  • Risk of trauma can be modified by physiological factors
• Psychological

Prevention

Should be aimed at both preventing the fall and injury secondary to the fall. It may be worthwhile to assess the risk of falling again.

Interventions that work

Are all multifaceted interventions

• All include exercise program
• All include targetted medical assessment beyond “normal” A&E and general practitioner practice
• most include OT/physio assessment
• in these subgroups:

1. A & E elderly fallers
2. multiple fallers in care homes
3. Community with stepped screening

Interventions that do not work

• those with moderate to severe dementia
• physiotherapy in the visually impaired

Evidence

• NICE guideline, Falls The assessment and prevention of falls in older people.
• Cochrane systematic review, Population-based interventions for the prevention of fall-related injuries in older people
• A non-Cochrane systematic review, Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials
• An EBM review, prophylactic use of vitamin D reduces falls in older persons

References