Assessment of Fall Risk Etiology

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Assessment of Fall Risk Etiology - #1

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Review assessments to consider in evaluating "falls".

Assessment

~~Possible Underlying Etiologies for Falls :
1. Cardiac/Pulmonary  - orthostatic hypotension, aortic stenosis, anemia, peripheral vascular disease
2. Central neurologic function – strokes, degenerative brain conditions, seizures, movement disorders (e.g. Parkinson’s disease, Huntington’s disease, demyelinating disorders), spine injuries
3. Cognitive impairment – dementia and/or delirium that may impair safe transit through a given environment
4. Diet & Nutritional factors – low vitamin D levels, thyroid dysfunction, low B12 or folate levels.
5. Endurance and functional impairments –ischemic heart disease and heart failure, COPD and other lung disease, arthritis, muscle weakness and impaired balance
6. Environmental:
a. Improper fit of shoes/clothes
b. Wet, slippery,irregular walking surfaces (e.g.,water, ice, high shag carpeting)
c. Poor lighting /glare
d. Obstructions / doorway thresholds
7. Gait disturbances:
a. Orthopedic and rheumatologic diseases that impair gait.
b. Foot and podiatric impairments – Charcot joints, plantar fasciitis, valgus/varus deformities.
8. Impairments in Activities of Daily Living (ADLs,  CADET)
9. Incontinence
10. Infection- causing delirium or dehydration and subsequent falls
11. Medications-  Inappropriate medication prescribing (Beers’ List, sedating medications, new medications, medication interactions)
12. Peripheral nervous system:neuropathies, radiculopathies (causing pain, decreased balance and function)
13. Psychiatric conditions- Depression, substance abuse/intoxication/withdrawalVestibular system dysfunction – benign positional vertigo, post traumatic vertigo, middle ear/inner ear infections, cholesteatomas and CNS tumors
14. Vision impairments – age related macular degeneration, diabetic retinopathy, glaucoma, cataracts, visual field impairments

 

 

Next steps to further define possible fall etiologies, consider the following assessments:

  • Orthostatic blood pressure
  • ECG​
  • Confrontational visual fields, Snellen Eye Chart
  • Proprioception, monofilament, vibratory sense
  • Romberg balance test
  • “Get Up and Go”
  • Neurologic function
  • Labs: B12, folate, thiamine, 25-hydroxy D3, thyroid stimulating hormone, complete metabolic panel, complete blood count

Context

Patient fall (home, institution)

Action

Perform a “falls assessment” to determine possible contributing factors to patient falls.

Incidence / Prevalence

A "fall is defined as an unexpected change in position from one level to another lower level. According to the CDC, 1/3 of adults aged 65 years and older fall annually. Falls are the leading cause of injury in the elderly, with 18,000 older adult deaths due to unintentional fall related injuries yearly.

Underlying Sciences

The underlying science will vary based on the etiology of the fall. There are numerous possibilities that may be contributing. EXAMPLES INCLUDE: Diabetic neuropathy – Increased glycosylation of hemoglobin due to increased plasma glucose levels may lead to neuronal cell damage and loss over time. Anticholinergic medications – Inhibition of the cholinergic neurotransmitters in the brain has been shown to predispose patients to falls.

Science Principles

Connective Tissue Changes
Impaired homeostasis

Guideline

American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. Guideline for the Prevention of Falls in Older Persons

Objectives

  1. List 10 possible underlying etiologies that may contribute to falls in elderly patients.
  2. Describe the assessment of falls, as outlined below in Figure 1.
  3. List 5 medical assessments/interventions that may be done to further assess potential fall etiologies.

Keywords/Tags

This GFF ___ my competence in geriatrics.

Authors

Suzanne Gehl, MD, Jennifer Scheeler, MD, Bonnie Bobot, MD, Heather Ho MD, Steven Denson, MD, Bambi Wessel

Copyright

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