Falls in the Elderly

Question 1

What are the risk factors for falls?

Answer 1

• Age, especially >75 years
• Ethnicity: Caucasian
• Housebound
• Living alone
• Previous falls
• Use of assistive device: cane, walker
• Acute Illness
• Chronic Conditions, especially neuromuscular (Parkinson’s)
• Medications (especially > 4 prescription meds)
• Nutritional deficiencies: Vitamin D/Calcium, protein
• Cognitive Deficits
• Reduced vision
• Presbycusis
• Difficulty rising from a chair
• Foot Problems
• Age related neurologic changes: prolonged reaction time, diminished sensory awareness, decline of the central integration of vestibular, sensory and proprioceptive information
• Environmental hazards (in the house or outside)

Question 2

What are the important physical exam parameters?

Answer 2

(I HATE FALLING)
I Inflammation of joints (or joint deformity)
H Hypotension (orthostatic blood pressure changes)
A Auditory and visual abnormalities
T Tremor (Parkinson’s disease or other causes of tremor)
E Equilibrium (balance) problem
F Foot problems
A Arrhythmia, heart block or valvular disease
L Leg-length discrepancy
L Lack of conditioning (generalized weakness)
I Illness
N Nutrition (poor appetite; weight loss)
G Gait disturbance

Question 3

***What is the MOST important physical exam parameter that we were told to REMEMBER!!!?

Answer 3

Hypotension!!! Can check orthostatic changes immediately, in office.

Question 4

What is the testing for fall risk assessment?

Answer 4

1. MFS Risk Assessment:
   Risk Level MFS Score Action
   No Risk 0 - 24 Good basic nursing care
   Low Risk 25 - 50 Implement standard fall prevention interventions
   High Risk ≥ 51 Prevention interventions
2. Get up and go test (get up from chair, walk 10 feet, and return to chair)
   • Normal = 8.5-10 sec.
   • > 10 seconds = increased risk of falls

Question 5

How do you manage and treat people at high risk for falls?

Answer 5

-Vitamin D/Calcium → increases bone density, improves CNS function, decrease sarcopenic effect of high PTH levels → improved muscle strength and postural equilibrium
-Exercise (must complete 50 hours of training to see reduction in fall rate)
-OMT – improve gait components (in Parkinson’s patients)
-Review medications:
• High risk: Benzodiazepines, SSRIs, Tricyclics, antihypertensives, narcotics, neuroleptics, anti-epileptics, sleep aids.
-Screen for depression (PHQ2):
• Little interest or pleasure in doing things?
• Do you feel down, depressed or hopeless?
• 90% sensitive
-Evaluate their environmental factors (bathroom, stairs, rugs, pathways, lighting, pets)
-Assisted devices (walkers) – if they need it