Geriatric Quick Consult      Falls in Older Patients       Do #2

Review risk factors for falls.

Knowledge Action

Syncope and near syncope from arrhythmias or seizures should not be overlooked but are not the most likely cause of falls. Any impairment of sensory, musculoskeletal, or cognitive function can increases the risk of falling. Generalized illness, such as pneumonia, UTI, must also be considered.

  1. Sensory
    • hearing loss
    • visual impairment
    • chronic dizziness
    • abnormal proprioception
      • peripheral neuropathy
      • B12 deficiency
  2. Musculoskeletal
    • arthritis
    • foot disorders
    • deconditioning, muscle weakness
  3. Central integrative
    • dementia
    • depression
    • gait disorders
    • stroke
    • parkinson’s
  4. Systemic
    • metabolic (thyroid)
    • acute illness (UTI, pneumonia etc.)
    • postural hypotension
    • postprandial hypotension
    • cardiovascular, carotid sinus hypersensitivity
 
  • Review risk factors for falling

  • Do a focused history and physical to identify risk factors for falling

  • Check:
    • hearing
    • vision
    • proprioception and soft touch
    • range of motion

  • Examine feet

  • Test muscle strength

  • Screen for impaired cognition, depression

  • Observe gait (see below)

  • Perform Romberg test

  • Check labs
    • CBC
    • BMP
    • TSH
    • UA
    • pulse-oximetry

  • Check for orthostasis

  • Consider carotid massage

A mnemonic to remember Causes/Risk factors for falls is: “AGAIN I’VE FALLEN"

Again - those who have fallen are at higher risk to fall again
Gait and balance
ADL loss
Impaired cognition
Number and type of drugs

Illness - An acute illness can cause a fall
Vestibular function
Eyes, ears

Feet
Alcohol
Low blood pressure,postural hypotension, post-prandial hypotension
Lower extremity weakness
Environment
Neurological
  • Remember the mnemonic “AGAIN I’VE FALLEN”

You should attempt to decrease any disease-related impairment.

For example, if a patient has visual impairment due to cataract, refer for extraction, or if a patient has an antalgic gait second to painful calluses, refer to a podiatrist. Other underlying problems are less reversible, like peripheral neuropathy (diabetic or other).

Physical therapy and exercise programs help to improve the sequelae of many diseases, such as gait instability and muscle weakness.

  • Modify as many risk factors as you can, especially those that seem most severe, or that most likely contribute to falls based on the history and physical exam.

  • Order consults and physical therapy when indicated
[Geriatric Quick Consults | Falls | Falls Do's and Don'ts ]