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This chapter addresses the following Geriatric Fellowship Curriculum Milestones: #16, #29, #41, #42, #52, #53

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LEARNING OBJECTIVES

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Learning Objectives

  • To be aware of the extent of the problem and consequences of falls in older people

  • To appreciate the broad range of risk factors for falls, and in particular, the risk factors that are amenable to correction through fall prevention initiatives

  • To be aware of appropriate fall risk screens and assessments for community, hospital, and residential aged care settings

  • To have knowledge of effective single and multifaceted interventions for preventing falls and the appropriate populations for which appropriate interventions should be targeted

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Key Clinical Points

  1. Falls are common in older people and frequently have serious consequences including fractures, significant fear of falling, reduced mobility and dependency, and need for institutional care.

  2. A broad range of risk factors for falls have been documented. Key among these are factors directly or indirectly influencing balance control and gait stability.

  3. Evidence-based screens and assessments are available for community, hospital, and residential aged care settings.

  4. Single intervention strategies shown to successfully prevent falls include exercise, enhanced podiatry, occupational therapy interventions, psychotropic medication withdrawal, cognitive behavioral therapy, expedited cataract extraction, provision of single lens glasses for regular multifocal glasses wearers, cardiac pacing for carotid sinus hypersensitivity and vitamin D supplementation in people with low levels of vitamin D.

  5. Tailored multifaceted and multifactorial interventions are the most effective interventions for preventing falls in high-risk populations including residential aged care facility (RACF) residents.

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EPIDEMIOLOGY OF FALLS AND FALL-RELATED INJURIES IN OLDER PEOPLE

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A fall is “an event which results in a person coming to rest inadvertently on the ground or floor or other lower level.” Prospective studies undertaken in community settings have reported fall incidence rates of 32% to 40% in people aged 65 or more, and fall rates of 40% to 50% in people beyond the age of 75. Prospective studies in residential aged care facilities (RACFs) report fall incidence rates between 30% and 56%. Falls also occur frequently when people are in hospital, with incidence rates ranging between 2% in general hospitals and 27% in acute hospital geriatric wards.

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Fall-related injuries can be severe and lead to a decline in the quality of life of an older person. Around 37% to 56% of all falls lead to minor injuries, while 10% to 15% of falls cause major injuries. Falls are the leading cause of injury-related hospitalizations in persons aged 65 and older, and account for 14% of emergency admissions and 4% of all hospital admissions in this age group. Falls that do not result in physical injuries can also have serious consequences including significant fear of falling, which can lead to reduced mobility and frailty through the avoidance of daily activities. Furthermore, falls constitute a key predisposing factor for older people requiring institutional care.

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RISK FACTORS ...

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