Falls Health Article

Treatment

Individuals who have fallen may have such injuries as fractures, dislocations, bruising, cuts to the skin, and muscle tears that may require casting, surgery, or hospitalization, depending on the severity. Initiation of lifelong medications for osteoporosis to reduce the rate of further bone loss may be indicated. Most people, including the frailest elderly, can usually benefit from an exercise program that includes strengthening and balance components. Assistance in regaining confidence may also be needed.

Someone who has fallen, once medically stable, needs to be evaluated for:

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

If deficits are noted and the reason for the fall is clear, a treatment plan can be developed that may include:

• balance training
• strength training
• aerobic exercise
• sensory integration
• correction of vision
• change in medication
• flexibility exercises
• hearing aids
• postural exercises
• patient education
• family and caregiver education
• analysis of environmental barriers
• gait retraining

Treatment may include the fabrication of an orthotic for lower limb dysfunction; prescription of an assistive device such as a cane or rolling walker; and education to the patient or caregiver regarding safety in the home.

Prognosis

How quickly and completely a patient recovers after a fall depends on the extent of the injury, the patient's medical condition prior to the fall, and the rehabilitation program. A positive attitude and adequate social support can be critical factors to a patient's recovery. Regaining mobility is critical, especially for the elderly patient who rapidly loses strength and function when immobile. A severe injury such as hip fracture has high morbidity and mortality, partially due to the long bed rest required after the injury.

Health care team roles

Nurses and other allied health professionals need to coordinate rehabilitation activities in an effort to integrate all facets of rehabilitation with functional activities. The rehabilitation team must take an active role in patient, caregiver, and family education, specifically related to restoring mobility and preventing falls in the home.

KEY TERMS

Coordination—The ability to do activities with precision and proficiency.

Electromyography—An evaluation tool that can detect electrical activity of muscles during an activity.

Force platform—A large plate, usually mounted in the floor, that records forces when an individual stands or walks on it.

Motion analysis—Use of an instrumented system to record whole-body and joint movement for later analysis.

Perturbation tests—Tests in which the patient stands on a platform, and a small, rapid movement of the platform is used to disturb balance. Forces and sway are recorded as the individual loses balance and then recovers.

Sensory perception—The ability to perceive touch, pressure, pain, and joint position in the limbs and trunk.

Transfers—The movement from one position to another, such as sit-to-stand, supine-to-sit, wheelchair-to-toilet, etc.

Prevention

Individuals, especially the elderly, should take the following steps to minimize their risk of falling:

• Take someone's arm when icy or slippery surfaces can not be avoided.
• Remove loose rugs from floors.
• Use only steady stepstools with hand supports when additional height is needed.
• Install hand rails on stairs.
• Wear good walking shoes.
• Assess the home for small objects and cords that can be tripped on as well as unstable pieces of furniture.
• Install grab bars next to toilets and in showers.
• Evaluate home lighting. Use night lights in bathrooms and between the bedroom and bathroom.
• Have vision and hearing checked regularly.
• Report dizziness, fainting, unusual sensations, or sud den loss of function to a physician at once.
• Engage in daily exercise that incorporates aerobics, weight training, and balance and coordination exercises.

BOOKS

Bennett S.E., J.L. Karnes. Neurological disabilities, assessment and treatment. Philadelphia: Lippincott, 1998.

Hertling D., R.M. Kessler. Management of Common Musculoskeletal Disorders. Baltimore, MD: Lippincott, Williams & Wilkins, 1996.

ORGANIZATIONS

"Falls and hip fractures among older adults." Centers for Disease Control. National Center for Injury Prevention and Control. <http://www.cdc.gov>. 2001.

Mark Damian Rossi, Ph.D, P.T., C.S.C.S.