PTINR.com
AGS Panel on Falls Prevention
Wednesday, June 1, 2005
PTINR.com Staff
The American Geriatric Society lists the most common reasons for falls. See how you can prevent dangerous falls in this month's feature article.
The American Geriatric Society published guidelines for the prevention of falls is a consensus of the American Geriatric Society, British Geriatric Society, and the American Academy of Orthopaedic Surgeons Panel on Falls Prevention. Published in 2001 – the information remains one of the most comprehensive works on fall prevention for geriatrics.
Many opportunities to prevent serious falls are overlooked with risks becoming evident only after the injury or disability. The Geriatric Society states, many patients are not aware of their own risks of falling thus fail to report them to their physicians.
The society published the following results of Univariate Analysis of Most Common Risk Factors for Falls Identified in 16 Studies that Examined Risk Factors:
Risk Factor |
Significant/Total* |
Mean RR-OR** |
Range |
Muscle weakness |
10/11 |
4.4 |
1.5-10.3 |
History of falls |
12/13 |
3.0 |
1.7-7.0 |
Gait deficit |
10/12 |
2.9 |
1.3-5.6 |
Balance deficit |
8/11 |
2.9 |
1.6-5.4 |
Use assistive device |
8/8 |
2.6 |
1.2-4.6 |
Visual deficit |
6/12 |
2.5 |
1.6-3.5 |
Arthritis |
3/7 |
2.4 |
1.9-2.9 |
Impaired ADL |
8/9 |
2.3 |
1.5-3.1 |
Depression |
3/6 |
2.2 |
1.7-2.5 |
Cognitive impairment |
4/11 |
1.8 |
1.0-2.3 |
Age > 80 years |
5/8 |
1.7 |
1.1-2.5 |
Studies categorized fall risks into two categories, intrinsic and extrinsic. Intrinsic risk factors included: lower extremity weakness, poor grip strength, balance disorders, functional and cognitive impairment, and visual deficits). Extrinsic risk factors included: polypharmacy (four or more prescription medications), and environmental factors such as poor lighting, loose carpets, and lack of bathroom equipment.
A study by Robbins et al. used a multivariate analysis to simply risk factors so
that maximum predictive accuracy could be obtained by using only three risk factors (hip weakness, unstable balance, taking 4 or more medications) in an algorithm format. With this model, the predictive 1-year risk of falling ranged from 12% for persons with none of the three risk factors to 100% for persons with all three. Arch Intern Med 1989
The panel makes specific recommendations in key areas where geriatrics have traditionally faltered. Areas include:
Exercise
Balance training held the strongest evidence supporting falls prevention. Other interventions included physician therapy and moderate strength training.
Environmental Modification
Recommendations of a home assessment is suggested upon an elderly patient discharge.
Medications
Pyschotropic medications were indicated in many falls. Patients benefited from a reduction in medications resulting in fewer falls. Medications to treat depression, arrhythmias and the widespread use of diuretics remain the three challenges for physicians treating geriatric patients.
Assistive Devices
Walkers and canes have been demonstrated to decrease falls in patients that use them. A stigma exists with some patients using such devices
Behavioral and Educational Programs
Behavioral and educational programs did yield demonstrated benefit. Structured group educational programs did not reduce the number of falls.
Bone Strengthening Medications
Medications to prevent or treat osteoporosis have shown a benefit in reducing fracture rates. While the agents played no role in fall prevention, they provided protection against more severe injuries.
Cardiovascular Intervention
Emerging evidence suggesting a cardiovascular link to some falls has caused a reevaluation of cardiac pacing management, orthostatic hypertension and vasovagal syndromes.
Visual Intervention
No randomized controlled trials have been conducted determining the role of impaired vision and falls. The AGS Panel recommended patients be questioned and tested for their vision acuity.
Footwear Interventions
No recommendations for specific footwear could be made due to lack of supportive studies. Balance has been noted in lower healed shoes for both men and women
Restraints
No evidence was presented showing that restraint of the patient resulted in fewer falls. There was a concern that restraints could contribute to serious injuries. No data suggests removal of restraints would reduce falls.
The AGS panel commented further work is needed in several key areas, some of them include:
• Cost effectiveness studies
• Risk stratification of patients
• Preventing falls for in-patients
• When is a professional home assessment appropriate
• What is the best footwear for fall prone patients
• The role of treatment of visual problems and fall reduction
For a complete listing and further information on fall prevention in older persons visit the American Geriatric online at: americangeriatrics.org