Around a third of elderly patients living in the community fall annually with 5-15% of falls resulting in significant injuries such as fractures and head trauma. In the UK there is 1 fall associated death every 5 hours. So, falls in the elderly pose a significant health problem.
The cause of a fall may not always be straight forward and may be multifactorial. Risk factors include increasing age, living in residential care and chronic disease.
Stroke, cerebellar disorders, visual impairment, Parkinsonism, seizures
MI, arrhythmia, orthostatic hypotension
Hypoglycaemia, hypothyroidism, dehydration
Arthritis, muscular weakness
Delirium, dementia, depression
Polypharmacy, antihypertensives, diuretics, alcohol
Poor lighting, steps, ice, shoes, rugs, walking aids
Depending on the circumstances, it may be necessary to obtain a collateral history.
Past Medical History
A detailed past medical history may indicate the cause. Specifically ask about:
The mnemonic I HATE FALLING can be used to remind you of the common treatable causes of falls which may be apparent on physical examination.
Inflammation of joints
Auditory and visual abnormalities
Tremor (e.g. Parkinson's)
Arrhythmia, heart block or valvular disease
Lack of conditioning (generalised weakness)
Nutrition (e.g. poor, weight loss)
An assessment of balance and gait could include:
Falls should be managed by firstly treating the underlying cause. The involvement of a multidisciplinary team including physiotherapists and occupational therapists is useful.
Modification of risk factors
The complications of falls can vary and include:
Akyol AD. Falls in the elderly: what can be done? International Nursing Review 2007;54:191–196.
Clark M, Kumar P. Kumar & Clark’s Clinical Medicine. 7th ed. pp 1096-7. London: Saunders Elsevier, 2009.
Longmore M, Wilkinson IB, Davidson EH, Foulkes A, Mafi AR. Oxford Handbook of Clinical Medicine. 8th ed. p 26. New York: Oxford University Press, 2010.
National collaborating centre for acute care. Head injury: Triage, assessment, investigation and early management of head injury in infants, children and adults. NICE, September 2007.
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