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risk factors for falls

Etiology: 1) weakness (4.9)* 2) balance deficit (3.2) 3) gait deficit (3.0) 4) vision deficit (2.8) - glaucoma, cataracts, & age-related macular degeneration [9] 5) mobility limitation (2.5) 6) cognitive deficit (2.4) 7) activities of daily living limitation (2.0) 8) hypotension a) postural hypotension (1.9) b) systolic blood pressure < 100 mm Hg 9) chronic musculoskeletal pain [7] a) factors associated with fall risk 1] multiple sites of pain 2] high pain severity 3] greater functional impairment b) possible mechanisms 1] joint pathology 2] neuromuscular dysfunction 3] interference with cognitive function 10) medications a) psychotropic drugs top the list - sedative/hypnotics - benzodiazepines - barbiturates - antipsychotics (any or all) - risperidone (produces parkinsonism) [5] - antidepressants [3] - tricyclic antidepressants (2.0) - selective serotonin reuptake inhibitors (2.0) b) 4 or more medications [6] c) diuretics* d) class 1a antiarrhythmic agents e) antihypertensive agents [5] f) Alzheimer agents 11) anemia [4] 12) enironmental risks - loose rugs, poor lighting, lack of hand rails 13) risk of a fall at home is greatest in the 2 weeks immediately following hospitalization [3] * Relative risk in parenthesis * history of a fall within the past year is the most predictive factor for falls in the elderly (GRS9) [3] Notes: - World Guidelines for Falls Prevention & Management's risk stratification algorithm in predicting falls with sensitivity score of 34% & specificity of 90% for predicting one or more falls with 24 months [10]

Related

falls in the elderly

General

health risk factor(s)

References

  1. Sepulveda GRECC guidelines
  2. Rubenstein LZ et al Falls in the nursing home. Ann Intern Med 121:442, 1994 PMID: 8053619
  3. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004; 7th edition 2010 - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
  4. Internal Medicine World Report 2006; 21(2) Penninx BW, Pluijm SM, Lips P, Woodman R, Miedema K, Guralnik JM, Deeg DJ. Late-life anemia is associated with increased risk of recurrent falls. J Am Geriatr Soc. 2005 Dec;53(12):2106-11. PMID: 16398894
  5. van der Velde N, van den Meiracker AH, Pols HA, Stricker BH, van der Cammen TJ. Withdrawal of fall-risk-increasing drugs in older persons: effect on tilt-table test outcomes. J Am Geriatr Soc. 2007 May;55(5):734-9. PMID: 17493193
  6. Medical Knowledge Self Assessment Program (MKSAP) 14, American College of Physicians, Philadelphia 2006
  7. Leveille SG et al. Chronic musculoskeletal pain and the occurrence of falls in an older population. JAMA 2009 Nov 25; 302:2214. PMID: 19934422
  8. Rafiq M, McGovern A, Jones S et al Falls in the elderly were predicted opportunistically using a decision tree and systematically using a database-driven screening tool. J Clin Epidemiol. 2014 Aug;67(8):877-86. PMID: 24786593
  9. Tsang JY et al. Risk of falls and fractures in individuals with cataract, age-related macular degeneration, or glaucoma. JAMA Ophthalmol 2023 Dec 28; [e-pub]. PMID: 38153708 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2813168
  10. Ragusa FS, Di Bella G, Dominguez LJ, The role of the World Guidelines for Falls Prevention and Management's risk stratification algorithm in predicting falls: a retrospective analysis of the Osteoarthritis Initiative. Age Ageing. 2024 Aug 6;53(8):afae187. PMID: 39171386