Falls in the elderly – assessment, therapy and prevention

Abstract

Falls have been identified as a major risk factor for disability. There is an increasing risk of falls and fall-related injuries in the elderly due to a decline in mobility and due to multimorbidity. Intrinsic and extrinsic factors lead to falls with and without syncope. Among nursing-home residents intrinsic factors are the main cause of falls, whereas community-dwelling elderly are more likely to fall because of environment (extrinsic) factors. Assessment of falls must be detailed, multidimensional and function-orientated, and aimed at identifying the causes of the index fall and risk-factors for further falls. As the risk of falling increases linearly with the number of abnormalities contributing to decreased mobility (mental status, mood, decline in sensory inputs, neurological and musculosceletal affections), identifying all risk factors increases the chance of successful intervention. Prevention of fall-related sequalae and further falls is the major goal of therapy. Primary prevention should be included in the scope of future strategies. The basis of successful intervention is fall-assessment, risk-factor assessment, causative therapy, if possible, as well as individually adapted function-orientated therapy programs, and, if at all possible, endurance and resistance training.