Falls and mobility

CME credit available from Harvard Medical School through April 2017.

The primary goal of the educational program is to help practitioners reduce the risk of falls in their elderly patients. This activity provides clinicians with a useful algorithm on how to identify patients at elevated falls risk, how to carry out a assessment of patients at higher risk, and how to tailor interventions to reduce this risk.

Falls are the leading cause of non-fatal injuries in the elderly.1 Every 13 seconds, on average, an older adult is taken to an emergency department in the U.S. because of a fall-related injury.2 Every 24 minutes, one of them dies as a result of a fall.1 A fall in an elderly patient can result in death and significant morbidity; over 90% of hip fractures in patients over 70 years old result from a fall; only half of these patients recover their pre-fracture mobility.3,5

 Consequences of hip fracture4

Falls - Consequences of Hip fracture

Despite the seriousness of these consequences, only about a third of older adults are regularly screened or assessed for their risk of falling.6

Falls are not a natural consequence of aging. Muscle weakness and gait problems are more important causes, and can be addressed.

Many factors contribute to a patient’s individual vulnerability to falling, and this vulnerability can change very rapidly, in some cases within hours. A highly vulnerable older person may fall as a result of a relatively minor insult, such as sudden postural change. On the other hand, a robust person with no risk factors may nonetheless lose balance and fall if confronted by difficult circumstances, such as an icy surface. A number of age-associated risk factors have been found to significantly increase the risk of falling. The more risk factors a patient has, the greater the vulnerability to falling when exposed to a stress.

What causes a fall?

Falls_What Causes a Fall?

 

All adults over the age of 65 years should be screened annually for risk of falls using three simple questions.

If a person answers yes to one or more of these questions, they are considered to be at a high fall risk and require an assessment. For those patients who answer no to all screening questions, but have fallen once in the prior 12 months, evaluate their gait and mobility with the Timed Up-and-Go (TUG) test.

Screening and assessment algorithm10

Falls - Screening Algorithm

 

 Evaluate gait and mobility with the Timed Up-and-GO (TUG) Test

Falls - Timed up and go test

Patients identified as “high risk” should be offered interventions tailored to their identified needs.

Multifactorial interventions targeted to specific risk factors can prevent a quarter of all falls, and reduce falls-related injury. A 2012 Cochrane review of recent multifactorial interventions found that community-based interventions reduced the rate of falls by 24%.11

The following interventions should be offered to all patient deemed at high risk of falling:

  • An exercise program to target strength, gait, and balance. Refer to a physical therapist when possible.
  • At least 1000 IU Vitamin D3 daily.
  • A home hazards evaluation, ideally delivered by an occupational therapist.

Information current at time of publication, April 2014.

The content of this website is educational in nature and includes general recommendations only; specific clinical decisions should only be made by a treating physician based on the individual patient’s clinical condition.

References
  1. Centers for Disease Control and Prevention. Falls Among Older Adults: An Overview. At: http://www.cdc.gov/homeandrecreationalsafety/Falls/data.html.
  2. Centers for Disease Control and Prevention. National Estimates of the 10 leading causes of nonfatal injuries treated in hospital emergency departments, United States – 2011. 2011.
  3. Keene GS, Parker MJ, Pryor GA. Mortality and morbidity after hip fractures. Bmj. Nov 13 1993;307(6914):1248-1250.
  4. Connecticut Collaboration for Fall Prevention. Connecticut Collaboration for Fall Prevention. Facts about Falls. http://www.fallprevention.org/pages/fallfacts.htm.
  5. American Geriatrics Society/British Geriatrics Society. Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons. Journal of the American Geriatrics Society. 2010.
  6. Podsiadlo D RS. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society. 1991;39:142-148.
  7. Gillespie LD RM, Gilespie WJ, et al.,. Interventions for preventing falls in older people living in the community. Cochrane database of systematic reviews (Online). 2012(9):CD007146.