Accidental fall: Difference between revisions

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Medications, especially psychotropic<ref name="pmid9920227">{{cite journal |author=Leipzig RM, Cumming RG, Tinetti ME |title=Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs |journal=Journal of the American Geriatrics Society |volume=47 |issue=1 |pages=30–9 |year=1999 |pmid=9920227 |doi=}}</ref> and cardiac<ref name="pmid9920228">{{cite journal |author=Leipzig RM, Cumming RG, Tinetti ME |title=Drugs and falls in older people: a systematic review and meta-analysis: II. Cardiac and analgesic drugs |journal=Journal of the American Geriatrics Society |volume=47 |issue=1 |pages=40–50 |year=1999 |pmid=9920228 |doi=}}</ref> are associated with increased risk of falling.
Medications, especially psychotropic<ref name="pmid9920227">{{cite journal |author=Leipzig RM, Cumming RG, Tinetti ME |title=Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs |journal=Journal of the American Geriatrics Society |volume=47 |issue=1 |pages=30–9 |year=1999 |pmid=9920227 |doi=}}</ref> and cardiac<ref name="pmid9920228">{{cite journal |author=Leipzig RM, Cumming RG, Tinetti ME |title=Drugs and falls in older people: a systematic review and meta-analysis: II. Cardiac and analgesic drugs |journal=Journal of the American Geriatrics Society |volume=47 |issue=1 |pages=40–50 |year=1999 |pmid=9920228 |doi=}}</ref> are associated with increased risk of falling.
Wearing multifocal eyeglasses may increase falls.<ref name="pmid19694864">{{cite journal| author=Menant JC, St George RJ, Sandery B, Fitzpatrick RC, Lord SR| title=Older people contact more obstacles when wearing multifocal glasses and performing a secondary visual task. | journal=J Am Geriatr Soc | year= 2009 | volume= 57 | issue= 10 | pages= 1833-8 | pmid=19694864
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19694864 | doi=10.1111/j.1532-5415.2009.02436.x }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref>


===Prevention===
===Prevention===

Revision as of 06:31, 6 November 2009

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An accidental fall is defined as a fall "due to slipping or tripping which results in injury".[1]

Falls in the elderly

At least a third of persons aged 65 years or more fall each year, with 10% leading to injury.[2]

Assessing risk

The presence of various medical conditions and the results of functional tests can assess the risk of falling.[3] Examples of such tests are Gait velocity and the Timed-Up-and-Go tests.[4] A Timed-Up-and-Go test of < 15 seconds suggests a low risk of falling.[5] In the Timed-Up-and-Go test "patients to stand up from a chair, walk a short distance, turn around, return, and sit down again."[6]

Causes

Buckling, or sudden giving way, of the knees is associated with osteoarthritis of the knees and quadriceps muscle weakness.[7]

Medications, especially psychotropic[8] and cardiac[9] are associated with increased risk of falling.

Wearing multifocal eyeglasses may increase falls.[10]

Prevention

Individual interventions

One randomized controlled trial reported that tai chi, one hour per week for 16 weeks, can prevent falls in patients aged 60 or more.[11]

A meta-analysis by the Cochrane Collaboration found benefit among cummunity-dwelling persons from:[12]

  • Individually targeted exercise or physical therapy consisting of strength training, balance, and walking.
  • Home safety interventions.

According to a subsequent meta-analysis by the Cochrane Collaboration, the role of modifying the home environment for the reduction of injuries has not been established.[13]

Withdrawing psychotropics mediations may prevent falls.[14][15]

Medications

Vitamin D may prevent falls by increasing muscle strength.[16]

Multifactorial interventions

A meta-analysis by the Cochrane Collaboration found benefit among cummunity-dwelling persons from multidisciplinary, multifactorial, health, or environmental risk-factor screening or intervention programs.[12] A more recent randomized controlled trial confirms this[17][18] although not all trials have shown benefit.[19]

References

  1. ↑ National Library of Medicine. Accidental Falls. Retrieved on 2007-10-17.
  2. ↑ Tinetti ME (2003). "Clinical practice. Preventing falls in elderly persons". N. Engl. J. Med. 348 (1): 42–9. DOI:10.1056/NEJMcp020719. PMID 12510042. Research Blogging.
  3. ↑ Thurman DJ, Stevens JA, Rao JK (2008). "Practice parameter: Assessing patients in a neurology practice for risk of falls (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology". Neurology 70 (6): 473–9. DOI:10.1212/01.wnl.0000299085.18976.20. PMID 18250292. Research Blogging.
  4. ↑ van Iersel MB, Munneke M, Esselink RA, Benraad CE, Olde Rikkert MG (2008). "Gait velocity and the Timed-Up-and-Go test were sensitive to changes in mobility in frail elderly patients". J Clin Epidemiol 61 (2): 186-91. DOI:10.1016/j.jclinepi.2007.04.016. PMID 18177792. Research Blogging.
  5. ↑ Nordin E, Lindelöf N, Rosendahl E, Jensen J, Lundin-Olsson L. Prognostic validity of the Timed Up-and-Go test, a modified Get-Up-and-Go test, staff's global judgement and fall history in evaluating fall risk in residential care facilities. Age Ageing. 2008 Jul;37(4):442-8. Epub 2008 May 30. DOI:10.1093/ageing/afn101 PMID 18515291
  6. ↑ Mathias S, Nayak US, Isaacs B. Balance in elderly patients: the "get-up and go" test. Arch Phys Med Rehabil. 1986 Jun;67(6):387-9. PMID 3487300
  7. ↑ Felson DT, Niu J, McClennan C, et al (2007). "Knee buckling: prevalence, risk factors, and associated limitations in function". Ann. Intern. Med. 147 (8): 534–40. PMID 17938391. [e]
  8. ↑ Leipzig RM, Cumming RG, Tinetti ME (1999). "Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs". Journal of the American Geriatrics Society 47 (1): 30–9. PMID 9920227. [e]
  9. ↑ Leipzig RM, Cumming RG, Tinetti ME (1999). "Drugs and falls in older people: a systematic review and meta-analysis: II. Cardiac and analgesic drugs". Journal of the American Geriatrics Society 47 (1): 40–50. PMID 9920228. [e]
  10. ↑ Menant JC, St George RJ, Sandery B, Fitzpatrick RC, Lord SR (2009). "Older people contact more obstacles when wearing multifocal glasses and performing a secondary visual task.". J Am Geriatr Soc 57 (10): 1833-8. DOI:10.1111/j.1532-5415.2009.02436.x. PMID 19694864. Research Blogging.
  11. ↑ Voukelatos A, Cumming RG, Lord SR, Rissel C (2007). "A randomized, controlled trial of tai chi for the prevention of falls: the Central Sydney tai chi trial". Journal of the American Geriatrics Society 55 (8): 1185–91. DOI:10.1111/j.1532-5415.2007.01244.x. PMID 17661956. Research Blogging.
  12. ↑ 12.0 12.1 Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH (2003). "Interventions for preventing falls in elderly people". Cochrane database of systematic reviews (Online) (4): CD000340. DOI:10.1002/14651858.CD000340. PMID 14583918. Research Blogging. [ACP Journal Club]
  13. ↑ Lyons RA, John A, Brophy S, et al (2006). "Modification of the home environment for the reduction of injuries". Cochrane database of systematic reviews (Online) (4): CD003600. DOI:10.1002/14651858.CD003600.pub2. PMID 17054179. Research Blogging.
  14. ↑ Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM (1999). "Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized, controlled trial". J Am Geriatr Soc 47 (7): 850–3. PMID 10404930. [e]
  15. ↑ Campbell AJ, Robertson MC (2007). "Rethinking individual and community fall prevention strategies: a meta-regression comparing single and multifactorial interventions". Age Ageing 36 (6): 656–62. DOI:10.1093/ageing/afm122. PMID 18056731. Research Blogging.
  16. ↑ Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R et al. (2009). "Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials.". BMJ 339: b3692. DOI:10.1136/bmj.b3692. PMID 19797342. Research Blogging.
  17. ↑ Tinetti M et al. (2008) Effect of Dissemination of Evidence in Reducing Injuries from Falls. New England Journal of Medicine
  18. ↑ Baker DI, King MB, Fortinsky RH, et al (April 2005). "Dissemination of an evidence-based multicomponent fall risk-assessment and -management strategy throughout a geographic area". J Am Geriatr Soc 53 (4): 675–80. DOI:10.1111/j.1532-5415.2005.53218.x. PMID 15817016. Research Blogging.
  19. ↑ Hendriks MR, Bleijlevens MH, van Haastregt JC, et al (July 2008). "Lack of Effectiveness of a Multidisciplinary Fall-Prevention Program in Elderly People at Risk: A Randomized, Controlled Trial". J Am Geriatr Soc. DOI:10.1111/j.1532-5415.2008.01803.x. PMID 18662214. Research Blogging.

External links

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