Falls in Older Adults: Risk Assessment, Management and Prevention

Moylan, Kyle; Binder, Ellen F.

doi:10.1016/j.amjmed.2006.07.022

Cited by 150 publications

(109 citation statements)

References 14 publications

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“…The interventions to reduce the risk of subsequent falls are targeted at modifying the contributory factors. [9,11] …”

Section: Pathophysiologymentioning

confidence: 99%

“…The value of documenting the functional status of a patient with falls is that functional impairments should be accounted for by cognitive, psychiatric and physical pathologies. [9,11] Impairments identified in the history, examination and investigation of a patient and the success of interventions to treat and manage these problems can be gauged by improvements in functional status. Functional status is measured in terms of instrumental activities of daily living (IADLs) (activities required for independent living in the community, such as housekeeping, cooking, shopping, use of transportation, management of finances, and maintaining hobbies and social contact) and activities of daily living (ADLs) (activities that enable a person to care for him/herself, such as bathing, grooming, dressing, toileting, continence and mobility on a level surface and stairs, and ability to transfer from bed to chair) (Fig.…”

Section: Medical History Examination and Investigationmentioning

confidence: 99%

“…Degenerative joint disease and osteoarthirits of the hips and knees are common in the elderly, as are foot problems such as corns, bunions and ingrown toenails. [11] Pain and deformity result in an abnormal gait, which increases the risk of falls, especially if there are multiple contributing factors. In the event of abnormal findings on the musculoskeletal examination, osteoarthritis, gout and rheu matoid arthritis should be considered (Fig.…”

Section: Medical History Examination and Investigationmentioning

confidence: 99%

“…Laboratory investigations include those guided by clinical suspicions or diagnoses arising from the medical assessment and screening for common conditions that may increase the risk of falls [11] (Table 2). …”

Section: Cognitive and Psychiatric Evaluationmentioning

confidence: 99%

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An approach to balance problems and falls in elderly persons

Villiers

Kalula

2015

S Afr Med J

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Gait instability and falls are common in elderly persons and have devastating consequences, with substantial morbidity and mortality. Furthermore, they are a precipitant for functional decline, increasing frailty and institutionalisation. The rate of falls and severity of complications increase with age and frailty. A consequence of falls with or without injury is that at least a third of persons develop a fear of falling, which leads to functional decline and a progressive decline in gait. The causes of falls in elderly persons are multifactorial and include physiological changes of ageing, frailty, pathologies, and environmental and situational factors. Maintaining postural control requires a complex integration of sensory input, central processing, motor coordination and musculoskeletal function, which decrease with ageing. This change, combined with sarcopenia, leads to slowed and weakened postural control and muscle responses, resulting in gait instability and falls.The assessment and management of a patient who is at risk of falls or who has fallen require a multidisciplinary approach to identify and address factors contributing to the fall. The assessment, which includes history, physical examination, and evaluation of gait, postural control and mental function, is aimed at identifying situational and associated factors surrounding a fall, intrinsic impairments in gait or pathologies that increase the risk of falls. The components of the assessment comprise a full medical evaluation for pathologies, including vision, medication review (including overthecounter medication) with regard to polypharmacy and highrisk medications, psychogeriatric review, functional status (instrumental activities of daily living (IADLs) and activities of daily living (ADLs)), functional assessment of gait and balance, and assessment of environmental hazards in the home. Laboratory investigations are guided by clinical suspicions or diagnoses arising from the medical assessment and screening for common conditions that may increase the risk of falls.Management and prevention of falls focus on maintaining mobility and balance, and identifying those at risk of a fall for multidisciplinary assessment and intervention. Intervention to reduce the risk of subsequent falls is targeted at modification of the contributory factors. Intervention includes management of underlying pathologies, strength and balance training by a physiotherapist, assessment and modification of environmental hazards in the home by an occupational therapist, medication review and rationalisation of highrisk medications and polypharmacy, and supplementation of vitamin D where indicated.

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“…The interventions to reduce the risk of subsequent falls are targeted at modifying the contributory factors. [9,11] …”

Section: Pathophysiologymentioning

confidence: 99%

Section: Medical History Examination and Investigationmentioning

confidence: 99%

Section: Medical History Examination and Investigationmentioning

confidence: 99%

Section: Cognitive and Psychiatric Evaluationmentioning

confidence: 99%

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An approach to balance problems and falls in elderly persons

Villiers

Kalula

2015

S Afr Med J

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“…Aging leads to a decline in regulation of the central nervous system, and the visual, vestibular, and somatic senses 4) , and also adversely affects cognition and the musculoskeletal system 5,6) . In particular, these physical changes cause a deterioration in balance and changes in gait 7) .…”

Section: Introductionmentioning

confidence: 99%

The Effect of Biofeedback-based Balance Training while Performing Cognitive Tasks on Temporal and Spatial Parameters and Gait Stability of the Elderly

2012

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Abstract.[Purpose] The purpose of this study was to investigate the effect of biofeedback-based balance training while performing cognitive tasks on gait of the elderly.[Subjects] Forty-one participants were selected from a fall prevention class and were randomly allocated to two groups: 20 to the experimental group (81.12 ± 7.24 years), and 21 to the control group (81.29 ± 6.19 years).[Methods] The experimental group received biofeedback-based balance training while performing cognitive tasks for 50 minutes a day, 3 days a week, for 8 weeks. Temporal and spatial parameters and stability were measured pre-and post-training.[Results] The experimental group showed significant improvements in all measures. [Conclusion] This study confirms that biofeedback-based balance training while performing cognitive tasks effectively improves the mobility of elderly people at risk of falling.

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Special Considerations

Buttaro¹

2012

Nursing Care of the Hospitalized Older Patient

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Falls in Older Adults: Risk Assessment, Management and Prevention

Cited by 150 publications

References 14 publications

An approach to balance problems and falls in elderly persons

An approach to balance problems and falls in elderly persons

The Effect of Biofeedback-based Balance Training while Performing Cognitive Tasks on Temporal and Spatial Parameters and Gait Stability of the Elderly

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