Falls in older adults


Falls in older adults are a significant cause of morbidity and mortality and are a major class of preventable injuries. The cause of falling in old age is often multifactorial and may require a multidisciplinary approach both to treat any injuries sustained and to prevent future falls. Falls include dropping from a standing position or from exposed positions such as those on ladders or stepladders. The severity of injury is generally related to the height of the fall. The state of the ground surface onto which the victim falls is also important, harder surfaces causing more severe injury. Falls can be prevented by ensuring that carpets are tacked down, that objects like electric cords are not in one's path, that hearing and vision are optimized, dizziness is minimized, alcohol intake is moderated and that shoes have low heels or rubber soles.
A review of clinical trial evidence by the European Food Safety Authority led to a recommendation that people over age 60 years should supplement the diet with vitamin D to reduce the risk of falling and bone fractures. Falls are an important aspect of geriatric medicine.

Definition

Other definitions are more inclusive and do not exclude "major intrinsic events" as a fall. Falls are of concern within medical treatment facilities. Fall prevention is usually a priority in healthcare settings.
A 2006 review of literature identified the need for standardization of falls taxonomy due to the variation within research. The Prevention of Falls Network Europe taxonomy for the definition and reporting of falls aimed at mitigating this problem. ProFane recommended that a fall be defined as "an unexpected event in which the participants come to rest on the ground, floor, or lower level." The ProFane taxonomy is currently used as a framework to appraise falls-related research studies in Cochrane Systematic Reviews.

Signs and symptoms

Falls are often caused by a number of factors. The faller may live with many risk factors for falling and only have problems when another factor appears. As such, management is often tailored to treating the factor that caused the fall, rather than all of the risk factors a patient has for falling.
Risk factors may be grouped into intrinsic factors, such as existence of a specific ailment or disease. External or extrinsic factors include the environment and the way in which it may encourage or deter accidental falls. Such factors as lighting and illumination, personal aid equipment and floor traction are all important in fall prevention.

Intrinsic factors

When assessing a person who has fallen, it is important to try to get an eyewitness account of the incident. As the faller may have had some loss of consciousness, they may not give an accurate description of the fall. However, in practice, these eyewitness accounts are often unavailable. It is also important to remember than 30% of cognitively intact older people are unable to remember a documented fall three months later.
Important points of inquiry:
Fall prevention is accomplished first with a detailed assessment of the risk for falls.
A large body of evidence shows that an efforts that include exercise decrease the risk of falls.
Possible interventions to prevent falls include:
Interventions to minimize the consequences of falls:
People who are hospitalized are at risk for falling. A randomized trial showed that use of a tool kit reduced falls in hospitals. Nurses complete a valid fall risk assessment scale. From that, a software package develops customized fall prevention interventions to address patients' specific determinants of fall risk. The kit also has bed posters with brief text and an accompanying icon, patient education handouts, and plans of care, all communicating patient-specific alerts to key stakeholders.

Screening

American Geriatrics society /British Geriatrics Society recommend that all older adults should be screened for "falls in the past year". Fall history is the strongest risk factor associated with subsequent falls. Older people who have experienced at least one fall in the last 6 months, or who believe that they may fall in the coming months, should be evaluated with the aim of reducing their risk of recurrent falls.
Many health institutions in USA have developed screening questionnaires. Enquiry includes difficulty with walking and balance, medication use to help with sleep/mood, loss of sensation in feet, vision problems, fear of falling, and use of assistive devices for walking.
Older adults who report falls should be asked about their circumstances and frequency to assess risks from gait and balance which may be compromised. A fall risk assessment is done by a clinician to include history, physical exam, functional capability, and environment.

Epidemiology

The incidence of falls increases progressively with age. According to the existing scientific literature, approximately one-third of the elderly population experiences one or more falls each year, while 10% experience multiple falls annually. The risk is greater in people older than 80 years, in which the annual incidence of falls can reach 50%.

History

Researchers have tried to create a consensual definition of a fall since the 1980s. Tinneti et al. defined a fall as "an event which results in a person coming to rest unintentionally on the ground or other lower level, not as a result of a major intrinsic event or overwhelming hazard.”

Economics

The health care impact and costs of falls in older adults are significantly rising all over the world. The cost of falls is categorized into 2 aspects: direct cost and indirect cost.
Direct costs are what patients and insurance companies pay for treating fall-related injuries. This includes fees for the hospital and nursing home, doctors and other professional services, rehabilitation, community-based services, use of medical equipment, prescription drugs, changes made to home and insurance processing.
Indirect costs include the loss of productivity of family caregivers and long-term effects of fall-related injuries such as disability, dependence on others and reduced quality of life.
In the United States alone, the total cost of falling injuries for people 65 and older was $31 billion in 2015. The costs covered millions of hospital emergency room visits for non-fatal injuries and more than 800,000 hospitalizations. By 2030, the annual number of falling injuries is expected to be 74 million older adults.

Research

Furthermore, a 2012 systematic review has demonstrated that performing dual-task tests may help in predicting which people are at an increased risk of a fall.