Falls are the same of the most comm...

Falls are the same of the most common geriatric syndrome threatening the independence of older bodys Between 30 and 40 percent of community-dwelling adults older than 65 years fall each year, and the rates are higher for nursing abiding-place residents. Falls are associated with increased morbidity, mortality, and nursing residence placement. Most falls have multiple causes. Risk factors for falls include muscle weakness, a history of falls, use of four or more prescription medications, use of an assistive device, arthritis, depression, age older than 80 years, and impairments in gait, balance, cognition, vision, and activities of daily living. Physicians caring for older patients should ask about any falls that have occurr in the past year. Assessment should include evaluating the circumstances of the fall and a completed history and physical examination, looking for potential risk factors. The in the greatest degree effective fall prevention strategies are multifactorial interventions targeting identified risk factors, exercises for muscle strengthening combined with balance training, and withdrawal of psychotropic medication. hearth hazard assessment and modification according to a health professional also is helpful.

**********

Falls are among the most numerous serious health concerns facing older patients. From 30 to 40 percent of community-dwelling adults older than 65 years fall each year. (12) Rates are higher in nursing to one's home residents and hospitalized patients. The incidence of falls rises steadily from middle age and peaks in someones older than 80 years. (3) Between 20 and 30 percent of older adults who fall feel serious injuries such as hip fractures and head trauma. (4) retrieval from falls often is complicated at poor quality of life caused by means of restricted mobility, functional decline, and increased risk for nursing dwelling placement. (3-5) Self-imposed functional limitations befitting to the fear of falling can cause post-fall anxiety syndrome This can lead to depression, feelings of helplessness, and social isolation.

Causes and Risk Factors

mostly falls result from a webwork interplay of predisposing and precipitating factors in a person's environment. common half to two thirds of falls present itself in or around the patient's hearth (2,4,6)

CAUSES

Environmental hazards are the leading cause of falls, accounting for about 25 to 45 percent in in the greatest degree studies. (3) Gait disturbance and muscle weakness also are everyday causes. Dizziness, vertigo, drop attacks, postural hypotension, visual impairment, and swoon also are known to cause falls (Table 1) (3)

RISK FACTORS

Lower extremity muscle weakness is a significant risk factor for falls, increasing the left over s of falling fourfold. (3) A history of fall and gait or balance deficits increases the risk threefold (3) Other high-risk situations that can cause or contribute to falls are use of an assistive device, visual deficit, arthritis, impaired activities of daily living, depression, cognitive impairment, and age older than 80 years. (7)

Use of four or more medications has been vehemently associated with an increased risk of falls. (8) In particular, use of psychotropic medications, cardiac mix with drugss including class 1A antiarrhythmic agents, digoxin, diuretics, and anticonvulsants have been implicated in increasing the risk of falls. (89) In a newly come study (10) of nursing family residents followed for one year, starting a fresh benzodiazepine or antipsychotic medication was associated with a true high risk (odds ratio = 11) for falls. Careful selection in prescribing, continual review, and withdrawal of unnecessary medications may render the risk of falls.

There is a positive correlation between increased risk of falling and the number of risk factors. Among a cohort of community-dwelling older adults, during common year of follow-up, the risk of falling increased from 8 percent for somebodys with no risk factor to 78 percent for parts with four or more risk factors. (2)

Assessment of Falls

Family physicians caring for older patients should integrate fall assessment into the annual history and physical examination. Many falls may at no time come to the physician's attention because the patient may not offer the information. A guideline in succession fall prevention published by the American Geriatric Society, the British Geriatric Society, and the American Academy of Orthopaedic Surgeon (7) approves that physicians caring for older patients should ask whether any falls have occurr in the past year. The panel also commits that an evaluation be performed upon patients who present with a fall, report intermittent falls, or have gait and balance abnormalities. Figure 1 (57) summarizes an approach to the assessment and management of falls in older persons

MEDICAL HISTORY

When evaluating a fall, physicians should obtain a description of the circumstances surrounding the fall and any associated symptoms. Additionally, the evaluation should include a thorough review of medications, assessment for acute and chronic medical question s mobility level, and functional and cognitive status.