geriatrics
Falls in Older Adults
Key Points
Each year in the United States, about one in four adults age ≥ 65 report a fall each year, for a total of about 14 millions falls. Not all falls result in an injury, but about 37% of adults who fall report an injury that required medical treatment or restricted activity for at least one day. Causes are multifactorial and include age-related functional declines (eg, reduced vision, slowed reaction time, muscle weakness), chronic illnesses that impair balance and mobility (eg, Parkinson disease, arthritis, dementia), adverse effects of medications, and environmental hazards. Use validated tools such as the Timed Up and Go test to determine the need for fuller assessment of predisposing intrinsic, extrinsic, and situational factors. To the extent possible, optimize treatment of comorbidities and contributing conditions, modify or eliminate causative medications, and correct environmental hazards. Emphasize the need to eliminate environmental hazards that commonly increase fall risk (eg, throw rugs, inadequate lighting, lack of grab bars and handrails, unstable furniture, clutter). Use multifactorial interventions for patients who have fallen more than once or have abnormalities in initial gait or impaired balance; interventions include referral for physical therapy and exercise programs, which are most effective when tailored and continued for ≥ 3 months. High-risk disorders such as Parkinson disease often require targeted treatment (eg, physical therapy, assistive devices) to reduce fall risk. Teach patients techniques to get up after a fall, especially when they are alone, and the importance of having a phone or emergency alert device accessible from the floor. 