Accidental fall

An accidental fall is defined as a fall "due to slipping or tripping which results in injury".

Falls in the elderly

At least a third of persons aged 65 years or more fall each year, with 10% leading to injury.

Assessing risk

The presence of various medical conditions and the results of functional tests can assess the risk of falling. Examples of such tests are Gait velocity and the Timed-Up-and-Go tests. A Timed-Up-and-Go test of < 15 seconds suggests a low risk of falling. In the Timed-Up-and-Go test "patients to stand up from a chair, walk a short distance, turn around, return, and sit down again."

A Timed-Up-and-Go test (stand=up; walk 10 feet; turn around; walk 10 feet; return to sitting) generally required 10 seconds.

Causes

Buckling, or sudden giving way, of the knees is associated with osteoarthritis of the knees and quadriceps muscle weakness.

Chronic muscle pain may be associated with an increased risk of falls.

Orthostatic hypotension may cause accidental falls.

Vision disorders

Wearing multifocal eyeglasses may increase falls.

Cataract surgery is associated with an increase in falls.

Medications

Medications, especially psychotropic and cardiac are associated with increased risk of falling.

Prevention

Clinical practice guidelines by the U.S. Preventive Services Task Force and American Geriatrics Society address prevention.

Individual interventions

"In community-dwelling older people at increased risk of falling, a 6-month music-based multitask exercise program improved gait under dual-task condition, improved balance, and reduced both the rate of falls and the risk of falling".

One randomized controlled trial reported that tai chi, one hour per week for 16 weeks, can prevent falls in patients aged 60 or more.

A meta-analysis by the Cochrane Collaboration found benefit among cummunity-dwelling persons from:

• Individually targeted exercise or physical therapy consisting of strength training, balance, and walking.
• Home safety interventions.

Substituting single lens eyeglasses may benefit persons who participate in regular outdoor activities.

Expedited surgery for a cataract may help.

According to a subsequent meta-analysis by the Cochrane Collaboration, the role of modifying the home environment for the reduction of injuries has not been established.

Withdrawing psychotropics mediations may prevent falls.

Medications

Vitamin D may prevent falls according to a systematic review by the U.S. Preventive Services Task Force. Vitamin D may be effective by increasing muscle strength.

The American Geriatrics Society recommends regarding vitamin D for prevention of accidental falls in geriatrics:

1. "Vitamin D supplements of at least 800 IU per day should be provided to older persons with proven vitamin D deficiency."
2. "Vitamin D supplements of at least 800 IU per day should be considered for people with suspected vitamin D deficiency or who are otherwise at increased risk for falls."

Multifactorial interventions

A meta-analysis by the Cochrane Collaboration found benefit among cummunity-dwelling persons from multidisciplinary, multifactorial, health, or environmental risk-factor screening or intervention programs. A more recent randomized controlled trial confirms this although not all trials have shown benefit.

Falls in hospitals

In hospitals, patients of any age may be confused. There are several approaches being used to detect when a patient, not cleared to be out of bed alone, may do so. Bed rails can be connected to a switch that sends a signal to the nursing station whenever they are lowered. Increasing numbers of new hospital beds are equipped with weight scales, originally for convenience in routine weighing, but now being used to detect when the patient's weight is removed from the mattress.

External links

• http://www.fallprevention.org/