A fall is a sudden and unintentional change in position resulting in an individual landing at a lower level such as on an object, the floor, or the ground, with or without injury. Falls are among the most common and serious problems facing elderly persons. Most falls are predictable and preventable: a fall can cause a loss in confidence which can lead to a decline in health and function and contribute to future falls. (1)
Why is it important?
30-50% of seniors experience a fall each year. About a 1/3 of these are serious falls with higher risk of adverse events.
Factors which indicate higher risk are presentation to physician or ER because of fall, fear of falling, multiple frequent falls and abnormal gait (assessed by Timed Up and Go).
Falling is associated with increased mortality, morbidity, reduced functioning, and LTCH admissions
Increased risk of serious falls in first six weeks after admission to LTC
Almost 62% of injury-related hospitalizations for seniors are the result of falls.
Fall-related injury rate is 9 times greater among seniors over 65 than those less than 65 years of age.
50% of seniors who fall experience a minor injury: 5% to 25% sustain an injury like a fracture or sprain
Falls cause 90% of all hip fractures in seniors: 20% die within a year of the fracture.
Often families are unable to provide care: 40% of LTCH admissions occur as a result of falls
Fall-related injury coupled with co-morbid diseases (e.g., osteoporosis) and age-related physiological decline (e.g., slower reflexes) make a mild fall dangerous.
The risk of falling dramatically increases as the number of risk factors increases.
↓ Sensory input (vision, hearing and proprioception)
↓Number motor neurons
↓Fast twitch fibers
↓ Vascular changes - prone to postural hypotension
Lower extremity weakness, balance / gait problems
Visual deficits, hearing loss
Acute or chronic illness
Depression, cognitive impairment
Dizziness / postural hypotension
Functional / ADL impairment
Psychotropics/Benzodiazepines; Digoxin, Diuretics
Class 1a anti-arrhythmics
Polypharmacy (5 or more)
History of falls, fear of falling
Excessive alcohol use (≥14 /wk)
Risk-taking behaviours (lack of insight)
Improper use of (or lack of use of) assistive device
Home hazards (kitchen, bathroom, bedroom)
Public / community hazards
Primary Care providers can significantly decrease the fall risk of their elderly patients by:
Screening for fall risk on admission and annularly.
Conducting a comprehensive post falls assessment to identify contributory causes and risk factors
Implementing multidisciplinary management strategies that target modifiable risk factor especially environmental factors and footwear
2. Cook, W.L., Donaldson, M.G., Janssen, P.A., Khan, K.M. and Sobolev B. (2009). Analysis of recurrent events: a systematic review of randomised controlled trials of interventions to prevent falls. Age Ageing. 2009 Mar; 38(2):151-5. Retrieved March 2014 from: http://www.ncbi.nlm.nih.gov/pubmed/19106254
3. National Institute for Health and Care Excellence. (2013). Falls: assessment and prevention of falls in older people: June 2013 NICE. Retrieved March 2014 from: http://guidance.nice.org.uk/CG161