ESSENTIALS OF DIAGNOSIS
Older adults who report more than one fall in the past year or a single fall with injury or gait and balance problems are at increased risk for future falls and injuries.
Acute factors (infectious, toxic, metabolic, ischemic, or iatrogenic) may contribute to falls and mobility disorders. Falling can be a sign of medical illness and is commonly the presenting symptom in older adults.
Medications, particularly psychotropic drugs, increase the risk for falls.
Common modifiable fall risk factors important to consider include visual acuity, home environmental hazards, and footwear.
As people age, their risk of falling increases. Approximately 30% of people older than the age of 65 years and 50% of people older than age 80 years fall each year. Almost 60% of those with a history of falls in the previous year will suffer from a subsequent fall. Up to 50% of falls result in some type of injury, the most serious of which includes hip fractures, head trauma, and cervical spine fractures. Injuries that occur as a result of falls rank seventh as a cause of accident-related deaths in the United States. This is continuing to rise, with a 30% increase in fall death rates in older adults from 2007 to 2016. If this trend continues, we can anticipate several fall deaths every hour by 2030. Multiple risk factors account for the increased rate of falls observed in older persons, and as such, falls are considered a geriatric syndrome.
One major risk factor for falls includes problems with mobility. The risk for developing a mobility disorder increases with age. Mobility disorders range from subclinical to obvious, and within this range, fall risk is elevated. Because the risk for mobility disorders and falls is increased in older persons, clinicians should be particularly aware of how to prevent and treat both. This chapter discusses falls and associated mobility disorders with regard to the background, epidemiology, risk factors, clinical evaluation, prevention, treatment, and prognosis of older persons who may be at risk or who have already developed mobility problems and recurrent falls.
An international fall outcomes consensus group, the Prevention of Falls Network Europe (ProFaNE), defines a fall as “an unexpected event in which the participant comes to rest on the ground, floor, or lower level.” Most falls do not result in serious physical injury, but those who fall are twice as likely to have a recurrent fall. In addition, many who experience an initial fall develop a fear of falling that itself can lead to an increased fall risk. Thus, it is particularly important to query about a history of falls when evaluating an older patient so that an appropriate evaluation and recommendations for prevention and treatment can be made before a significant injury occurs.
Mobility disorders refer to any deviation from normal walking. To walk normally, control of ...