Geriatrics and Gerontology - Hazzard's
FALLS
half of older persons who sustain a hip fracture cannot
return home or live independently after the fracture, and up to 20%
die within a year of the fracture. Falls
account for approximately 20% of restricted activity days in older
people—more than for any other health condition. Risk of pneumonia,
dehydration and rhabdomyolysis due to long lies.
Age greater than 80 years, need for assistance with activities of
daily living, and previous falls, indicate risk for future falls.
The most important modifiable intrinsic risk factors for falls are balance, strength, and gait impairments. Impairment
in these areas may be caused by a number of sensory, neurological,
or musculoskeletal diseases, in addition to deconditioning
as a result of lack of activity, age-related changes, and medication
effect.
With quiet standing, there is little movement of the center
of mass. The area over the feet within which a person is able to lean
decreases with age. Fall risk has been linked to mediolateral instability;
clinically this can be tested by the ability to stand in tandem stance or on one leg, both of which reduce the mediolateral base of
support. The effect of impaired performance of static balance tasks
may be manifested in activities such as walking and transferring.
Persons who experience difficulty with standing balance tasks may
walk more slowly and therefore spend a greater percentage of the
gait cycle in more stable double stance with a wider base of support.
A loss of balance may be caused by the speed or magnitude of displacement,
an inability to quickly detect the displacement because of
sensory impairment, slowing of central nervous system integration
of sensory information into a motor response, or muscle weakness or
joint pain, causing an inadequate or ineffective response. Older persons
take compensatory steps at lower levels of balance disturbance
than young adults, but may have less effective stepping responses
(multiple steps, difficulty controlling lateral stability) with greater
challenges to balance. Older persons are slower than young adults
in initiating reaching reactions to break a fall or grasp a handrail.
Depression may increase fall risk because of decreased
concentration or awareness of potential environmental hazards.
Postural hypotension: drop in systolic blood pressure of 20mmHg or more with a change in position from sitting to standing.
