Who is at Risk for Falls?

Who is at risk of falling | Walk'n'Chair | Walker Wheelchair Combo
Who is at risk of falling? Certainly the elderly with unstable gait are prone to fall. But that just about describes us all at some point in our lives.

More specifics on who falls can be found by looking at standardized and validated questionnaires. For example, the CAREFALL triage questionnaire was developed to assess a person’s risk of falling. It identifies characteristics that correlate to the possibility of future falls (van Hensbroek et al., 2009).

The factors correlated to the risk of falling are:

  • Age
  • Female
  • Medication
  • Impaired Vision
  • Fear of Falling
  • Mood
  • Osteoporosis
  • Orthostatic hypotension
  • Balance /
  • Mobility
  • Urinary Incontinence

Major risk factors for falling are advancing age and female gender. These risk factors are unavoidable, but medication and impaired vision are also major risks. Over-prescription of medication is a prevalent problem as a patient bounces from ER to hospital to doctor. Doctors do not cancel always medications and more get added every emergency room visit. The risk of falling from impaired vision may be managed by safety engineering the home and optimizing the vision.

Moderately strong predictors of falls include fear of falling (previous falls), mood, and high risk of osteoporosis. Fear of falling is a predictor of a future fall and should trigger an intervention by a physical therapist or other clinician. Depression is a predictor of falling and also may reflect a reaction to previous falls. Osteoporosis, may increase the fear of and severity of falling, is a predictor of falling.

Fair predictors of falls included orthostatic hypotension, balance / mobility, and urinary incontinence. Orthostatic hypotension is a reduced blood pressure when standing. It can lead to “wooziness” or dizziness. Orthostatic hypotension can be checked for by your doctor with a blood pressure cuff. Blood pressure will be taken while sitting and then again right after standing. If the blood pressure drops more than 20 mmHg, this points to orthostatic hypotension. Orthostatic hypotension is common in Parkinson’s subjects and may be due to Levodopa (Sinemet). Reduced mobility and balance are obviously important factors causing falls. Balance and gait training may help prevent falls. Urinary incontinence is associated with risk of falling. The nerves to the bladder and legs can both be affected. The opportunity to fall may be increased with many trips to the bathroom.

Other risk factors for falling include (Ambrose and Hausdorff, 2013):
• Cognitive decline (particularly attention)
• Environmental factors

Folding Walker | Walker Wheelchair Combo | Helps Prevent Falls

What can be done about reducing falls?

Multifactorial interventions are recommended as falls are caused by multiple factors. So what are these interventions?

    Anti-fall interventions should include:

  • exercise, particularly balance, strength, and gait training (for improving balance and righting reflexes);
  • vitamin D supplementation with or without calcium (osteoporosis reduction);
  • management of medications, especially psychoactive medications (improvement of attention, gait, balance);
  • home / outdoor environment modification (rails, removal of sharp corners);
  • management of postural hypotension (Sit first before standing, check medication side effects)
  • management of vision problems,
  • management of foot problems, and footwear. (Moncada and Mire 2017).

Fall prevention is reimbursed as part of the Medicare Annual Wellness Visit

The US Preventative Services Task Force (USPSTF) recommends exercise interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls. (B recommendation) The USPSTF recommends that clinicians selectively offer multifactorial interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls. “When determining whether this service is appropriate for an individual, patients and clinicians should consider the balance of benefits and harms based on the circumstances of prior falls, presence of comorbid medical conditions, and the patient’s values and preferences.” (USPSTF 2018)

30-40% of people aged >65 will fall at least once

References:

Ambrose AF, Paul G, Hausdorff JM. (2013) Risk factors for falls among older adults: a review of the literature. Maturitas. 2013 May; 75(1):51-61. doi: 10.1016/j.maturitas.2013.02.009. Epub 2013 Mar 22.

van Hensbroek PB, van Dijk N, van Brenda GF, Scheffer AC, van der Cammen TJ, Lips P, Goslings JC, de Rooij SE, Combined Amsterdam and Rotterdam Evaluation of Falls (CAREFALL) Study Group (2009) The CAREFALL triage instrument identifying risk factors for recurrent falls in elderly patients. Amer J Emergency Med 27:23-36.

Scheffer AC, van Hensbroek PB, van Dijk N, Luitse JS, Goslings JC, Luigies RH, de Rooij SE.(2013) Risk factors associated with visiting or not visiting the accident & emergency department after a fall. BMC Health Serv Res. 2013 Jul 26;13:286. doi: 10.1186/1472-6963-13-286.

Moncada LVV, Mire LG. (2017) Preventing Falls in Older Persons. Am Fam Physician. 2017 Aug 15;96(4):240-247.

US Preventive Services Task Force, Grossman DC, Curry SJ, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW Jr, Kemper AR, Krist AH, Kubik M, Landefeld S, Mangione CM, Pignone M, Silverstein M, Simon MA, Tseng CW. (2018) Interventions to Prevent Falls in Community-Dwelling Older Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2018 Apr 24;319(16):1696-1704. doi: 10.1001/jama.2018.3097

Comments are closed.