Accidental fall

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An accidental fall is defined as a fall "due to slipping or tripping which results in injury".[1][2]

Falls in the elderly

At least a third of persons aged 65 years or more fall each year, with 10% leading to injury.[3]

Assessing risk

The presence of various medical conditions and the results of functional tests can assess the risk of falling.[4] Examples of such tests are Gait velocity and the Timed-Up-and-Go tests.[5] A Timed-Up-and-Go test of < 15 seconds suggests a low risk of falling.[6] 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."[7]

Causes

Buckling, or sudden giving way, of the knees is associated with osteoarthritis of the knees and quadriceps muscle weakness.[8]

Chronic muscle pain may be associated with an increased risk of falls.[9]

Wearing multifocal eyeglasses may increase falls.[10]

Medications

Medications[11], especially psychotropic[12] and cardiac[13] are associated with increased risk of falling.

Prevention

Clinical practice guidelines address prevention.[14]

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.[15]

A meta-analysis by the Cochrane Collaboration found benefit among cummunity-dwelling persons from:[16]

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

Substituting single lens eyeglasses may benefit persons who participate in regular outdoor activities.[17]

Expedited surgery for a cataract may help.[2][18]

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.[19]

Withdrawing psychotropics mediations may prevent falls.[20][21]

Medications

Vitamin D may prevent falls by increasing muscle strength.[22][23]

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.[16] A more recent randomized controlled trial confirms this[24][25] although not all trials have shown benefit.[26]

References

  1. ↑ Anonymous (2024), Accidental falls (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. ↑ 2.0 2.1 Tinetti ME, Kumar C (2010). "The patient who falls: "It's always a trade-off".". JAMA 303 (3): 258-66. DOI:10.1001/jama.2009.2024. PMID 20085954. Research Blogging. Cite error: Invalid <ref> tag; name "pmid20085954" defined multiple times with different content
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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
  7. ↑ 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
  8. ↑ 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]
  9. ↑ Leveille SG, Jones RN, Kiely DK, Hausdorff JM, Shmerling RH, Guralnik JM et al. (2009). "Chronic musculoskeletal pain and the occurrence of falls in an older population.". JAMA 302 (20): 2214-21. DOI:10.1001/jama.2009.1738. PMID 19934422. Research Blogging.
  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. ↑ Woolcott JC, Richardson KJ, Wiens MO, Patel B, Marin J, Khan KM et al. (2009). "Meta-analysis of the impact of 9 medication classes on falls in elderly persons.". Arch Intern Med 169 (21): 1952-60. DOI:10.1001/archinternmed.2009.357. PMID 19933955. Research Blogging.
  12. ↑ 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]
  13. ↑ 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]
  14. ↑ American Geriatric Society Prevention of Falls
  15. ↑ 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.
  16. ↑ 16.0 16.1 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]
  17. ↑ Haran, Mark J; Ian D Cameron, Rebecca Q Ivers, Judy M Simpson, Bonsan B Lee, Michael Tanzer, Mamta Porwal, Marcella M S Kwan, Connie Severino, Stephen R Lord (2010-05-25). "Effect on falls of providing single lens distance vision glasses to multifocal glasses wearers: VISIBLE randomised controlled trial". BMJ 340 (may25_1): c2265. DOI:10.1136/bmj.c2265. Retrieved on 2010-05-26. Research Blogging.
  18. ↑ Harwood RH, Foss AJ, Osborn F, Gregson RM, Zaman A, Masud T (2005). "Falls and health status in elderly women following first eye cataract surgery: a randomised controlled trial.". Br J Ophthalmol 89 (1): 53-9. DOI:10.1136/bjo.2004.049478. PMID 15615747. PMC PMC1772474. Research Blogging.
  19. ↑ 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.
  20. ↑ 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]
  21. ↑ 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.
  22. ↑ Kalyani RR, Stein B, Valiyil R, Manno R, Maynard JW, Crews DC (2010). "Vitamin D treatment for the prevention of falls in older adults: systematic review and meta-analysis.". J Am Geriatr Soc 58 (7): 1299-310. DOI:10.1111/j.1532-5415.2010.02949.x. PMID 20579169. Research Blogging.
  23. ↑ 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.
  24. ↑ Tinetti M et al. (2008) Effect of Dissemination of Evidence in Reducing Injuries from Falls. New England Journal of Medicine
  25. ↑ 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.
  26. ↑ 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.

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