Falls
Definition
When someone falls over. Durr. More specifically, when they fall over, and get some kind of pathology resulting from that.
Epidemiology
30% of over 65's fall at least once a year, half of these falling at least twice and the risk increases with age. 5% require hospitalisation. It is estimated that falls cost the UK £1.7 billion a year so it is important to be able to diagnose the cause of a fall.
Risk Factors
There are a variety of factors which can increase risk. The following are broadly speaking the groups in which to these risk factors can categorised:
Neuro/muscular/both factors
- Muscle weakness
- Gait deficit
- Mobility limitiation
Neurological
- Visual impairment
- Balance deficit (including dizziness)
- Seizures
- Cognitive impairment
- Consciousness impairment (sudden or gradual)
Cardiological
- Postural hypotension
- Arrhythmias
- Syncope - ie from aortic stenosis
Iatrogenic
- Psychotropic medication - benzodiazepines, antidepressants and antipsychotics
- BP lowering drugs
- Anticonvulsants
These can be attributed as direct causes of falls but there are other factors which increase risk without being direct causally linked:
- Comorbid conditions
- Others
- PMHx: history of fall in the last year
- Age (<80 years)
- Use of assistive device i.e. walking stick
Clinical Features
Falling over is really the key manifestation of falling.
Investigations
Screen for
- neurological problems: such as MS, or Parkinson's, both of which can present with mobility problems.
- alcohol abuse
- cardiac arrhythmias
- impaired vision
Management
Prognosis
According to this study, if someone has a fall, their risk of hospitalisation increases significantly. With that hospitalisation, there is an increased risk of death in the next year.
However, if someone falls and doesn't require hospitalisation, their risk of death is not affected, unless they fall a lot.