Falls Health Article

Definition

Falls are a common source of injury, particularly in the elderly population. They are more likely to occur if impairments in balance, strength, perception, joint range of motion, postural function or coordination are present. Serious injury from falls, such as fractures, occur commonly in people with osteoporosis, a common degenerative disease involving loss of bone mass. Hip fracture is one of the most serious potential consequences of a fall, with a mortality rate as high as 20%.

Description

Falling is a serious health problem in the United States, especially for the elderly. According to the National Center for Injury Prevention and Control, one in every three adults 65 years of age and older falls each year, with an increasing incidence as a person ages. Falls can result in serious injury, not only posing a burden on the individual who falls, but also on family members and the health care system.

Causes and symptoms

Falls can often be attributed to environmental hazards. Icy sidewalks and uneven terrain are common dangers. In the home, climbing on unstable step stools, sliding in wet showers, or slipping on throw rugs are frequent causes of falls.

Medical factors can also make falls more likely to occur. Orthostatic hypotension, sensory loss, stroke, dementia, medications, and neuromuscular disease increase the risk of falling. Deficits in strength, joint range of motion, coordination, sensory perception, and vision may further impair balance. Osteoporosis, common in the elderly population, makes a fall more likely to result in serious injury.

Diagnosis

Individuals who are at risk of falling because of a medical condition or medications need to be routinely

Falls among people 65 years of age and older

Falls are the leading cause of accidental deaths in persons over 65 years of age.

Falls are the seventh leading cause of death among people older than 65 years.

In the United States 75% of deaths from falls occur in the 12% of the population that is older than 65 years.

From 75 years of age the rate of death from falls rises for both genders and all racial groups.

Thirty-three percent of healthy community-dwelling elders (older than 65 years) fall annually.

Sixty-seven percent of nursing home residents fall annually.

Between 33% and 67% of older patients in hospital-like environments fall annually.

Complications from falls or prolonged floor contact after falls include fear of falling, dehydration, pressure sores, hypothermia, pneumonia, and rhabdomyolysis.

Whites who fall have twice the hip fracture rate as persons from other racial groups.

Five percent of falls among older people will result in fractures.

The most common fractures as a result of falls among the elderly are humeral, wrist, pelvis, and hip, with the presence of osteoporosis making fractures more likely.

Ten to twenty percent of falls among older people will result in soft-tissue injuries, with 50% of these requiring medical care.

Falls contribute to 40% of admissions to nursing homes.

Seventy percent of emergency room visits by people older than 75 years are due to falls.

SOURCE: National Center for Health Statistics, 1980, 1984.

tested for instability during functional activities. The following characteristics should also be assessed:

• balance
• strength
• sensation
• vision
• joint range of motion
• hearing
• postural awareness
• gait

Balance

Balance testing can be done in a rehabilitation facility to assess people's ability to transfer weight and control their center of gravity. Numerous tests such as the Berg balance assessment, functional reach test, get-upand-go test, and Tinnetti tests are useful in a balance evaluation.

Strength

Strength testing should be done to identify weakness, strength asymmetry between sides, and muscle strength imbalance within the same limb.

Sensation

Sensation testing of the lower extremities assesses light touch, pressure, and limb awareness.

Vision

Vision should be assessed by a licensed professional. If corrective lenses are indicated, they should be used during further testing, such as balance and gait assessment.

Joint range of motion

Joint motion assessment evaluates the loss of range of motion and its relationship to impairments in transfers and gait.

Hearing

If hearing loss is suspected, it should be tested and corrected, if possible, before rehabilitation is addressed.

Postural awareness

In a rehabilitation center, individuals can be put through a battery of tests that assess perception of the center of gravity with relation to the environment. Specific tests include postural sway tests and perturbation tests.

Gait

Walking can be evaluated by direct observation to assess for gait abnormalities. If a severe gait disturbance is present, further gait analysis using motion analysis, force platforms, and electromyography should be done.