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Key Features

Essentials of Diagnosis

  • Falls in older people are rarely due to a single cause

  • Medications are a common and potentially reversible cause of falls in elders

General Considerations

  • With age, balance mechanisms can become compromised, reaction time lengthens, and postural sway increases

  • These changes predispose the older person to a fall when challenged by an additional insult to any of these systems

  • Effective intervention entails a comprehensive assessment of the patient's intrinsic deficits (usually diseases and medications), the activity engaged in at the time of the fall, and environmental obstacles

  • Intrinsic deficits are those that impair

    • Sensory input

    • Judgment

    • Blood pressure regulation

    • Reaction time

    • Balance and gait

  • Dizziness may be closely related to the deficits associated with falls and gait abnormalities

  • Medications (eg, benzodiazepines, sedative-hypnotics, cardiac medications, antidepressants, neuroleptics) and polypharmacy have been associated with increased risk of falls

  • Postural hypotension, including postprandial

  • Acute medical illness (pneumonia, myocardial infarction)

  • Other contributing factors

    • Urinary urgency

    • Peripheral edema

    • Insomnia

    • Use of multifocal lenses

    • Footwear

  • See Table 4–4

Table 4–4.Fall risk factors and targeted interventions and best evidence for fall prevention.

Demographics

  • Falls are the leading cause of nonfatal injuries in older persons

  • Complications from falls are the leading cause of death from injury in persons over age 65

  • About one-third of people over 65 fall each year, and the frequency increases markedly with advancing age

Clinical Findings

Symptoms and Signs

  • Assessment should include

    • Postural blood ...

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