Falls in Seniors

Falls in Seniors

• Falls are common in people 65 years and older, with a prevalence between 10% and 25%.
• Falls frequently occur during simple daily activities like walking or standing up.
• Falls are associated with high comorbidity, accelerating the loss of independence, and a high rate of institutionalization (up to 40%).

Underreporting of Falls

• Falls are often under reported by patients and their families.
• Doctors and caregivers may not inquire about falls.
• Patients, families, and caregivers may mistakenly believe falls are inevitable.
• The cause of a fall may not be investigated.
• A substantial number of falls could be prevented in the community with effective risk management.

Epidemiology of Falls

• Among individuals 65 years and older, 30-40% experience a fall each year.
• Among individuals 80 years and older, 50% experience a fall each year.
• 50% of those who fall experience multiple falls.

Definition of a Fall

• A fall is generally defined as losing one's balance and being pulled to the ground by gravity.
• According to the WHO, falling or slipping on the ground is unintentional.

Repeated Falls

• Criteria include falling to the ground or to a lower level involuntarily and experiencing two or more falls within 12 months.

Causes of Falls

• Predisposing factors are related to illnesses and disabilities (intrinsic factors).
• Precipitating factors include accidental causes linked to cardiovascular, neurological, vestibular, metabolic, and environmental risks (extrinsic factors).

Identifying At-Risk Individuals

• Conditions that increase the risk of falls include cardiovascular diseases (Hypo TA), neurological issues (confusion, vertigo), and metabolic conditions (diabetes, hypo Na).

Risk Factors

Precipitating Factors

• Illnesses like cardiovascular conditions (hypotension), neurological issues such as confusion, vestibular problems like vertigo, and metabolic conditions like diabetes or low sodium levels. Environments
• Poor lighting, cluttered spaces, and inappropriate footwear.

Predisposing Factors

• Aging, being female, using multiple medications and psychotropic drugs, balance problems.
• Decreased muscle strength, arthritis, impaired vision, depression, cognitive decline, history of falls, confusion and malnutrition.

Situational Factors

• Falls can occur because of chronic diseases, age-related issues, intrinsic factors (gait disorders, neurological issues, muscle weakness, osteoarthritis), and extrinsic factors (environmental hazards).

Intrinsic Factors

• Factors include gait disturbances, physiological changes, neurological issues, muscular atrophy, and osteoarthritis.

Extrinsic Factors

• Cognitive and mood disorders, fear of falling, history of falls, syncope, orthostatic hypotension, cardiac issues, visual impairment, and urinary incontinence.

Situational Factors

• In the home: stairs, unsuited bathrooms.
• Outdoors: collecting cherries, ice, walking the dog, mostly experienced in patients with psychiatric conditions.

Non-Modifiable vs. Modifiable Risk Factors

• Non-modifiable: age, gender, history of falling, cognitive and prior stroke.
• Modifiable: gait problems, unstable balance, lower limb weakness, orthostatic hypotension, depression, medications.

Evaluating a Patient Who Falls

• Collect a targeted history of circumstances, previous conditions, symptoms, and medicines
• Assess mobility, articulation, muscular, CV functions, cognitive abilities, and vision

Targeted History

• Circumstances, frequency, associated symptoms, impact, length of time on the ground.

Status

• Assess mobility (gait, balance), muscle strength in lower limbs, neurological function (cognitive, cerebellar, pyramidal, extrapyramidal reflexes, proprioception), cardiovascular function (rate, rhythm, blood pressure), and vision (acuity).

Key Assessments

• Inquire about circumstances, past medical conditions, associated symptoms, and current mediations

Functional Evaluation

• Assess the need for assistive devices, fear of falling, and environmental risks in the home (rugs, stairs, electrical cords).

Clinical Examination After a Fall

• A global assessment should look for chronic risk factors and extrinsic triggers.
• Assess the environment, autonomy, resources, and alarm systems.

Environmental Safety

Home Assessment

• Stairs, slippery floors, inadequate lighting.

Additional tests

Recommended Tests

• Test de Double tâche (dual task)
• SPPB (Short Physical Performance Battery)
• Timed Get Up and Go
• Tinetti

Tests

• Simple to conduct tests such as tandem stand, gait speed, and the "Timed Get Up and Go" test can provide valuable information and insights.

Post-Fall Syndrome

• The syndrome includes a tendency to fall backward, altered balance, hypertonia, and requires specific physical therapy. This affects 20% of patients post-fall.

The "Spirale Infernale"

• Fear of falling, reduced mobility, and dependence

Guidelines

• Steps include detection, investigating the causes, and taking immediate action

Falls Can Result In

• Falls can result in physical injuries and/or an inability to rise without assistance.

Three Recommendations from HAS on Fall Management

• First, identify signs of severity. Second, investigate risk factors. Third, implement interventions and provide support.

Factors in Fall Severity

• Severity linked to the consequences, responsible pathologies, and the recurring nature of falls.

Potential issues

• Physical trauma , rhabdomyolysis, hypothermia, pneumonia
• Cardiac/neurological etiologies, including arrhythmias, CVA, MI, or infection.
• Recent changes in frequency / multiple risk factors.
• Recognized osteoporosis, anticoagulation.

Evaluation for fall

• Radiological and biochemical in fractures. CPK for over one hour on ground. ECG malaise, glucose test if patient is diabetic.

Prevention of Falls

• Screening for fall risk, identifying hazards, and implementing medical and paramedical prevention measures.

Handling Falls

• Support and encourage the person to rise on their own if physically possible, building self-confidence.

Actions

• Actions such as clearing the room, lowering the bed, safety barriers.
• Installation and maintenance of equipment as well as assessing footwear.
• Medical check ups or food surveillance.

Preventative Steps

• In the event of a fall, promote autonomy by encouraging individuals with the aid of people present.
• Falls may be the result of multiple factors (intrinsic and environmental risks). There is no unique risk factor and falls are generally accidental and severe. They should always be considered.