Fall in Elderly

Fall in elderly

Adel Gassab Mohammed
MD, CABMS, MSc of Medicine Specialist Endocrinologist, Thi-Qar Specialized Diabetes, Endocrine and Metabolism Center, Lecturer Diabetes, Endocrine and Metabolism Division, Department of Medicine, College of Medicine, University of Thi-Qar,

• Outline:

• Introductions of falls in elderly.
• Cause and risk factors of falls.
• Consequences of falls in elderly.
• Assessment of fall in elderly.
• Preventing falls in older people.
• Summary.

• Definition of Falls

• A fall is defined as an event which results in a person coming to rest inadvertently on the ground or floor or other lower level.

• Introduction

• Falls and fall-related injuries are a common& serious problem for older people.
• Fall potentially life- threatening events and may be simply the first signs of single problem.
• It lead to hospitalization and increase cost and burden on society and even lead to death .

• Intrinsic risk factors:

• Age Related changes (Visual function Neurological function, Musculoskeletal function)
• Diseases Female sex
• Extrinsic risk factors:
• Drugs Environmental Improper assistive
• devices

• (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; weight loss)
• G: Gait disturbance

• Consequence of falls

• Physical:
• Skin tear internal bleeding
• subdural hematoma Hip fracture Immobilization /
• disability
• Hospitalization
• Psychological:
• Fear of falling increased dependency Depression
• Anxiety
• loss of confidence social withdrawal

• ASSESSMENT OF FALL

• How to approach elderly with fall

• History

• Examination

• Investigations

• History

• A thorough history is essential to determine:

• Fall ( mechanism of fall, Location, Activity, Injury related to the fall, witness/help)
• Associated symptoms concurrent with a fall (change in level of or loss of consciousness, chest pain, palpitations, dizziness, vertigo or lightheadedness, Symptoms related to a change in position ,headache, weakness/tingling/numbness or acute change in mental status)

• previous falls and whether the falls were the same or different in character.

• medical history
• Medications
• Functional history
• Social history


• Physical Examination
• General looking Hydration status postural changes
• Vital signs( orthostatic hypotension) Visual & Hearing abnormalities

• Cardiovascular: murmur ,presence of arrhythmias & carotid bruits

• Neurologic and mental evaluation: looking for focal deficits, assessment of lower extremity peripheral nerves,
• proprioception, vibration sense, and tests for cortical, cerebellar, and extrapyramidal functions is important.

• Musculoskeletal: lower-extremity weakness, presence of contractures, limitations or pain in range of motion
• Gait and balance: abnormalities, lower extremity strength, and joint function.
• Environmental assessment: Lighting, walking surface, furniture, clothing, and equipment

• Testing and imaging

• Complete blood count, Electrolyte, Blood urea nitrogen , Creatinine , Glucose , Thyroid function, Vitamin B12 levels
• X-ray
• ECG, ECHO, EEG
• Brain imaging(CT/MRI)
• DEXA(dual-energy x-ray absorptiometry)

• The American Geriatrics Society and British Geriatrics Society recommend that all adults older than 65 years be screened annually for a history of falls or balance impairment.

• Evaluate gait, strength, and balance

• Recommended test:
• Timed Up and Go
• Optional tests:
• 30-Second Chair Stand 4-Stage Balance tests

• https://youtu.be/Ng-UOHjTejY

• https://youtu.be/3HvMLLIGY6c
• https://youtu.be/BA7Y_oLElGY

• PREVENTION OF FALL

• Participate in regular physical activity. Exercise makes you stronger, increases flexibility and improves balance and coordination. ...
• Remove hazards in your home. ...
• Review your medications regularly. ...
• Have your vision and hearing checked once a year. ...
• Talk to your family members and enlist their help.
Five Safe Steps to Prevent Falls Among Elderly

• Multifactorial falls risk assessment

• identification of falls history
• assessment of visual impairment
• assessment of cognitive impairment and neurological examination
• cardiovascular examination and medication review.
• assessment of gait, balance and mobility, and muscle weakness
• assessment of osteoporosis risk
• assessment of the older person's perceived functional ability and fear relating to falling
• assessment of urinary incontinence
• assessment of home hazards


• Multifactorial interventions

• An intervention with multiple components that aims to address the risk factors for falling that are identified in a person's multifactorial assessment.

• MULTIFACTORIAL INTERVENTIONS

• Multifactorial interventions should include: Exercise, particularly balance, strength, and gait training
• Vitamin D supplementation with or without calcium
• Management of medications Home environment modification
• Management of postural hypotension, vision problems, foot problems, and footwear.

• Improve home supports.

• Provide opportunities for socialization and encouragement.
• Involve the family.
• Provide follow-up.

• Rehabilitation

• Adequate rehabilitation physically, socially, and psychologically of injured person is very important post fall.




• SUMMARY

• Healthcare professional should routinely ask about falls

• Identify if being at risk of falling Multifactorial risk assessment Multifactorial risk intervention

• Elderly aged 65 or above