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Essentials of Diagnosis

  • Older adults who report >1 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.

  • 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.

General Principles in Older Adults

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 include hip, head trauma, and cervical spine fractures. Injuries that occur as a result of a falls contribute to a rate of accident-related deaths that rank seventh as a cause of death in the United States. 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. As is true with falls, 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 are increased in older persons, clinicians should be particularly aware of factors important in preventing and treating both. This chapter discusses falls and associated mobility disorders with regards 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.

A fall is defined as “inadvertently coming to rest on the ground or other lower level with or without loss of consciousness” (Close, 1999). Most falls do not result in serious physical injury, but those who fall become at increased risk for recurrent falls. 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 balance and posture both at rest and with movement is necessary. Thus, normal gait requires a complex integration of adequate strength, sensation, and coordination. For a normal healthy adult, walking is almost automatic, but in fact, the control of gait and posture is both complex and multifactorial, and a defect ...

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