Falls are one of the most common geriatric syndromes threatening the independence of older persons. About 40 percent of community-dwelling adults older than 65 years fall each year, and the rates are higher for nursing home residents. Falls are associated with increased morbidity, mortality, and nursing home placement. Most falls have multiple causes.
Risk factors for falls include muscle weakness, a history of falls, use of four or more prescription medications, use of an assistive device, arthritis, depression, age older than 80 years, and impairments in gait, balance, cognition, vision, and activities of daily living. Physicians caring for older patients should ask about any falls that have occurred in the past year. Assessment should include evaluating the circumstances of the fall and a complete history and physical examination, looking for potential risk factors.
The Cochrane Collaboration conducted a systematic review of fall prevention studies incorporating exercise programs such as progressive muscle strengthening, balance training, and a walking plan, individually tailored for each participant by a trained health professional. Pooled data from these studies indicate that such programs significantly decreased the number of individuals experiencing a fall over one year when compared with a control group that received no intervention. The number of patients injured during a fall also was significantly reduced. The evidence was strongest for balance retraining, supporting inclusion of these exercises as a component of fall prevention programs. ( http://www.aafp.org/afp/20050701/81.html )
Wolf SL, Barnhart HX, Kutner NG, McNeely E, Coogler C, Xu T. Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. J Am Geriatr Soc 1996;44:489-97.
The patient with vertigo, syncope or fear of falling is often difficult to manage, since they usually do not respond well to antivert,meclizine or valium.
