Fall Etiology and Assessment - #15Take Quiz
Learn to assess multiple factors causing falls.
Ask all patients about falls in the past two years or if patient presents with a fall
If single, recurrent falls or near misses → Intervention →
No falls → No Intervention
ASSESSMENT / ROS
I Hate Falling
I: Inflammation of joint or joint deformity
A: Auditory and visual abnormalities
E: Equilibrium (balance)
F: Foot problems
A: Arrhythmia, heart block, valvular disease
L: Leg-length discrepancy
L: Lack of conditioning (generalized weakness)
G: Gate disturbance
-Orthostatic blood pressure
-Confrontational visual fields, Snellen Eye Chart
-Propnoception, monofilament, vibratory sense
-Romberg balance test
-"Get Up and Go"
-Labs: B12, folate, thiamine, 25-hydrozy D3, TSH, CMP, CBC
Refer to Fast Facts #16 - Falls Risk: Factors & Interventions
Tap image to enlarge.
Elderly patient fall (home, institution)
Perform a “falls assessment” to determine possible contributing factors to patient falls when the etiology is not clear. Tripping without falling should also be evaluated as it helps to assess potential environmental risks. Repeated falls should be evaluated individually as they may have different etiologies.
A “fall” is defined as an unexpected change in position from one level to another lower level. According to the CDC, 1/3 of adults aged 65 years and older fall annually. Falls are the leading cause of injury in the elderly and result in 18,000 deaths due to fall related injuries annually.
- List 10 possible underlying etiologies that may contribute to falls in elderly patients.
- Describe the assessment of falls, as outlined below in figure 1.
- List 5 medical assessments (physical exam or lab studies) that may be done to further assess potential fall etiologies.
Review of Systems (ROS)
- Michael YL, Whitlock EP, Lin JS, Fu R, O'Connor EA, Gold R; US Preventive Services Task Force. Primary care-relevant interventions to prevent falling in older adults: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2010 Dec 21; 153(12):815-25. http://www.ncbi.nlm.nih.gov/pubmed/21173416
- American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. Guideline for the prevention of falls in older persons. J Am Geriatr Soc 2001; 49:664–672. http://www.ncbi.nlm.nih.gov/pubmed/11380764
- Fuller, G. F. Falls in the elderly. Am Fam Physician. 2000 Apr 1; 61(7):2159-2168. http://www.ncbi.nlm.nih.gov/pubmed/10779256
Users are free to download and distribute Geriatric Fast Facts for informational, educational, and research purposes only. Citation: Yana Thaker, Kathyrn Denson MD, Steven Denson MD, Bambi Wessel, Fast Fact #15: Fall Etiology and Assessment, February 2012.
Disclaimer: Geriatric Fast Facts are for informational, educational and research purposes only. Geriatric Fast Facts are not, nor are they intended to be, medical advice. Health care providers should exercise their own independent clinical judgment when diagnosing and treating patients. Some Geriatric Fast Facts cite the use of a product in a dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.