Accidental fall

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An accidental fall is defined as a fall "due to slipping or tripping which results in injury".[1][2]

Falls in the elderly

At least a third of persons aged 65 years or more fall each year, with 10% leading to injury.[3]

Assessing risk

The presence of various medical conditions and the results of functional tests can assess the risk of falling.[4] Examples of such tests are Gait velocity and the Timed-Up-and-Go tests.[5] A Timed-Up-and-Go test of < 15 seconds suggests a low risk of falling.[6] In the Timed-Up-and-Go test "patients to stand up from a chair, walk a short distance, turn around, return, and sit down again."[7]

A Timed-Up-and-Go test (stand=up; walk 10 feet; turn around; walk 10 feet; return to sitting) generally required 10 seconds.[8]

Causes

Buckling, or sudden giving way, of the knees is associated with osteoarthritis of the knees and quadriceps muscle weakness.[9]

Chronic muscle pain may be associated with an increased risk of falls.[10]

Orthostatic hypotension may cause accidental falls.[11]

Vision disorders

Wearing multifocal eyeglasses may increase falls.[12]

Cataract surgery is associated with an increase in falls.[13]

Medications

Medications[14], especially psychotropic[15] and cardiac[16] are associated with increased risk of falling.

Prevention

Clinical practice guidelines by the U.S. Preventive Services Task Force[17] and American Geriatrics Society[18] address prevention.

Individual interventions

"In community-dwelling older people at increased risk of falling, a 6-month music-based multitask exercise program improved gait under dual-task condition, improved balance, and reduced both the rate of falls and the risk of falling".[19]

One randomized controlled trial reported that tai chi, one hour per week for 16 weeks, can prevent falls in patients aged 60 or more.[20]

A meta-analysis by the Cochrane Collaboration found benefit among cummunity-dwelling persons from:[21]

  • Individually targeted exercise or physical therapy consisting of strength training, balance, and walking.
  • Home safety interventions.

Substituting single lens eyeglasses may benefit persons who participate in regular outdoor activities.[22]

Expedited surgery for a cataract may help.[2][23]

According to a subsequent meta-analysis by the Cochrane Collaboration, the role of modifying the home environment for the reduction of injuries has not been established.[24]

Withdrawing psychotropics mediations may prevent falls.[25][26]

Medications

Vitamin D may prevent falls according to a systematic review by the U.S. Preventive Services Task Force.[27] Vitamin D may be effective by increasing muscle strength.[28][29]

The American Geriatrics Society recommends regarding vitamin D for prevention of accidental falls in geriatrics:[30]

  1. "Vitamin D supplements of at least 800 IU per day should be provided to older persons with proven vitamin D deficiency."
  2. "Vitamin D supplements of at least 800 IU per day should be considered for people with suspected vitamin D deficiency or who are otherwise at increased risk for falls."

Multifactorial interventions

A meta-analysis by the Cochrane Collaboration found benefit among cummunity-dwelling persons from multidisciplinary, multifactorial, health, or environmental risk-factor screening or intervention programs.[21] A more recent randomized controlled trial confirms this[31][32] although not all trials have shown benefit.[33]

Falls in hospitals

In hospitals, patients of any age may be confused. There are several approaches being used to detect when a patient, not cleared to be out of bed alone, may do so. Bed rails can be connected to a switch that sends a signal to the nursing station whenever they are lowered. Increasing numbers of new hospital beds are equipped with weight scales, originally for convenience in routine weighing, but now being used to detect when the patient's weight is removed from the mattress.

References

  1. Anonymous (2015), Accidental falls (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. 2.0 2.1 Tinetti ME, Kumar C (2010). "The patient who falls: "It's always a trade-off".". JAMA 303 (3): 258-66. DOI:10.1001/jama.2009.2024. PMID 20085954. Research Blogging.
  3. Tinetti ME (2003). "Clinical practice. Preventing falls in elderly persons". N. Engl. J. Med. 348 (1): 42–9. DOI:10.1056/NEJMcp020719. PMID 12510042. Research Blogging.
  4. Thurman DJ, Stevens JA, Rao JK (2008). "Practice parameter: Assessing patients in a neurology practice for risk of falls (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology". Neurology 70 (6): 473–9. DOI:10.1212/01.wnl.0000299085.18976.20. PMID 18250292. Research Blogging.
  5. van Iersel MB, Munneke M, Esselink RA, Benraad CE, Olde Rikkert MG (2008). "Gait velocity and the Timed-Up-and-Go test were sensitive to changes in mobility in frail elderly patients". J Clin Epidemiol 61 (2): 186-91. DOI:10.1016/j.jclinepi.2007.04.016. PMID 18177792. Research Blogging.
  6. Nordin E, Lindelöf N, Rosendahl E, Jensen J, Lundin-Olsson L. Prognostic validity of the Timed Up-and-Go test, a modified Get-Up-and-Go test, staff's global judgement and fall history in evaluating fall risk in residential care facilities. Age Ageing. 2008 Jul;37(4):442-8. Epub 2008 May 30. DOI:10.1093/ageing/afn101 PMID 18515291
  7. Mathias S, Nayak US, Isaacs B. Balance in elderly patients: the "get-up and go" test. Arch Phys Med Rehabil. 1986 Jun;67(6):387-9. PMID 3487300
  8. Bohannon RW (2006). "Reference values for the timed up and go test: a descriptive meta-analysis.". J Geriatr Phys Ther 29 (2): 64-8. PMID 16914068[e]
  9. Felson DT, Niu J, McClennan C, et al (2007). "Knee buckling: prevalence, risk factors, and associated limitations in function". Ann. Intern. Med. 147 (8): 534–40. PMID 17938391[e]
  10. Leveille SG, Jones RN, Kiely DK, Hausdorff JM, Shmerling RH, Guralnik JM et al. (2009). "Chronic musculoskeletal pain and the occurrence of falls in an older population.". JAMA 302 (20): 2214-21. DOI:10.1001/jama.2009.1738. PMID 19934422. Research Blogging.
  11. Romero-Ortuno R, Cogan L, Foran T, Kenny RA, Fan CW (2011). "Continuous noninvasive orthostatic blood pressure measurements and their relationship with orthostatic intolerance, falls, and frailty in older people.". J Am Geriatr Soc 59 (4): 655-65. DOI:10.1111/j.1532-5415.2011.03352.x. PMID 21438868. Research Blogging.
  12. Menant JC, St George RJ, Sandery B, Fitzpatrick RC, Lord SR (2009). "Older people contact more obstacles when wearing multifocal glasses and performing a secondary visual task.". J Am Geriatr Soc 57 (10): 1833-8. DOI:10.1111/j.1532-5415.2009.02436.x. PMID 19694864. Research Blogging.
  13. Meuleners LB, Fraser ML, Ng J, Morlet N (2013). "The impact of first- and second-eye cataract surgery on injurious falls that require hospitalisation: a whole-population study.". Age Ageing. DOI:10.1093/ageing/aft177. PMID 24192250. Research Blogging.
  14. Woolcott JC, Richardson KJ, Wiens MO, Patel B, Marin J, Khan KM et al. (2009). "Meta-analysis of the impact of 9 medication classes on falls in elderly persons.". Arch Intern Med 169 (21): 1952-60. DOI:10.1001/archinternmed.2009.357. PMID 19933955. Research Blogging.
  15. Leipzig RM, Cumming RG, Tinetti ME (1999). "Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs". Journal of the American Geriatrics Society 47 (1): 30–9. PMID 9920227[e]
  16. Leipzig RM, Cumming RG, Tinetti ME (1999). "Drugs and falls in older people: a systematic review and meta-analysis: II. Cardiac and analgesic drugs". Journal of the American Geriatrics Society 47 (1): 40–50. PMID 9920228[e]
  17. Prevention of Falls in Community-Dwelling Older Adults
  18. American Geriatric Society Prevention of Falls
  19. Trombetti A, Hars M, Herrmann FR, Kressig RW, Ferrari S, Rizzoli R (2011). "Effect of music-based multitask training on gait, balance, and fall risk in elderly people: a randomized controlled trial.". Arch Intern Med 171 (6): 525-33. DOI:10.1001/archinternmed.2010.446. PMID 21098340. Research Blogging.
  20. Voukelatos A, Cumming RG, Lord SR, Rissel C (2007). "A randomized, controlled trial of tai chi for the prevention of falls: the Central Sydney tai chi trial". Journal of the American Geriatrics Society 55 (8): 1185–91. DOI:10.1111/j.1532-5415.2007.01244.x. PMID 17661956. Research Blogging.
  21. 21.0 21.1 Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH (2003). "Interventions for preventing falls in elderly people". Cochrane database of systematic reviews (Online) (4): CD000340. DOI:10.1002/14651858.CD000340. PMID 14583918. Research Blogging. [ACP Journal Club]
  22. Haran, Mark J; Ian D Cameron, Rebecca Q Ivers, Judy M Simpson, Bonsan B Lee, Michael Tanzer, Mamta Porwal, Marcella M S Kwan, Connie Severino, Stephen R Lord (2010-05-25). "Effect on falls of providing single lens distance vision glasses to multifocal glasses wearers: VISIBLE randomised controlled trial". BMJ 340 (may25_1): c2265. DOI:10.1136/bmj.c2265. Retrieved on 2010-05-26. Research Blogging.
  23. Harwood RH, Foss AJ, Osborn F, Gregson RM, Zaman A, Masud T (2005). "Falls and health status in elderly women following first eye cataract surgery: a randomised controlled trial.". Br J Ophthalmol 89 (1): 53-9. DOI:10.1136/bjo.2004.049478. PMID 15615747. PMC PMC1772474. Research Blogging.
  24. Lyons RA, John A, Brophy S, et al (2006). "Modification of the home environment for the reduction of injuries". Cochrane database of systematic reviews (Online) (4): CD003600. DOI:10.1002/14651858.CD003600.pub2. PMID 17054179. Research Blogging.
  25. Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM (1999). "Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized, controlled trial". J Am Geriatr Soc 47 (7): 850–3. PMID 10404930[e]
  26. Campbell AJ, Robertson MC (2007). "Rethinking individual and community fall prevention strategies: a meta-regression comparing single and multifactorial interventions". Age Ageing 36 (6): 656–62. DOI:10.1093/ageing/afm122. PMID 18056731. Research Blogging.
  27. Michael YL, Whitlock EP, Lin JS, Fu R, O'Connor EA, Gold R et al. (2010). "Primary care-relevant interventions to prevent falling in older adults: a systematic evidence review for the U.S. Preventive Services Task Force.". Ann Intern Med 153 (12): 815-25. DOI:10.1059/0003-4819-153-12-201012210-00008. PMID 21173416. Research Blogging.
  28. Kalyani RR, Stein B, Valiyil R, Manno R, Maynard JW, Crews DC (2010). "Vitamin D treatment for the prevention of falls in older adults: systematic review and meta-analysis.". J Am Geriatr Soc 58 (7): 1299-310. DOI:10.1111/j.1532-5415.2010.02949.x. PMID 20579169. Research Blogging.
  29. Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R et al. (2009). "Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials.". BMJ 339: b3692. DOI:10.1136/bmj.b3692. PMID 19797342. Research Blogging.
  30. AGS/BGS Clinical Practice Guideline (2011). Prevention of Falls in Older Persons
  31. Tinetti M et al. (2008) Effect of Dissemination of Evidence in Reducing Injuries from Falls. New England Journal of Medicine
  32. Baker DI, King MB, Fortinsky RH, et al (April 2005). "Dissemination of an evidence-based multicomponent fall risk-assessment and -management strategy throughout a geographic area". J Am Geriatr Soc 53 (4): 675–80. DOI:10.1111/j.1532-5415.2005.53218.x. PMID 15817016. Research Blogging.
  33. Hendriks MR, Bleijlevens MH, van Haastregt JC, et al (July 2008). "Lack of Effectiveness of a Multidisciplinary Fall-Prevention Program in Elderly People at Risk: A Randomized, Controlled Trial". J Am Geriatr Soc. DOI:10.1111/j.1532-5415.2008.01803.x. PMID 18662214. Research Blogging.

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