2. Learning objectives
Recognize the significance of
falls as a public health issue.
Identify the risk factors
associated with falls.
Describe the potential
consequences of falls.
Understand the components of a
comprehensive falls assessment.
Explain the principles of falls
● Injurious falls is a true geriatric
syndrome and serious clinical
problems facing older adults.
● Falls result in signiﬁcant morbidity
and mortality and an increased rate of
nursing home placement.
● Each year, approximately 30% of
persons older than 65 years fall at
least once, and this figure rises to
more than 40% in those aged over 80.
● About 1 in 40 of older persons will be
hospitalized due to falls, nearly half of
them will die within a year.
● Within long-term care institutions,
fall rates are even higher, almost
two falls per patient per year.
● Moreover, falls in institutions more
commonly have serious
complications (10-25% are
associated with a fracture or
● In the United States, direct medical
costs related to falls in elderly
people exceeded $19 billion in
4. The problem of falls in older persons is a
A high incidence of falls in this age group.
Elderly people are high susceptibilityto
injury after falls.
Recovery from fall injury is often delayed
in older persons.
Falls increasing risk for subsequent falls
Falls are frequently have serious
significant fear of falling,reduced
mobility and dependency,and need for
Post fall anxiety syndrome can result in
loss of self-conﬁdence,fear, depression,
social isolation, and increasedrisk of falls
5. Risk Factors
The multiple risk factors for falling can be
categorized as intrinsic or extrinsic.
Intrinsic risk factors include age-related
physiologic changes and diseases that
affect the risk of falling.
Extrinsic risk factors include medications
and environmental obstacles.
Key factors are those directly or indirectly
influencing balance control and gait
The chance of falling increases
signiﬁcantly in people with multiple risk
6. Risk Factors
Walking and balance difficulties.
Fear of falling.
Vitamin D deficiency.
Medical conditions (Orthostatic
hypotension, osteoarthritis, Parkinson's
disease, brain stroke, urinary
incontinence, depression, cognitive
Intrinsic Risk Factors
7. Risk Factors
Psychotropic, antiarrhythmic, diuretic
Dim or glaring lighting.
Lack of stair handrails.
Poor stair design.
Tripping hazards (raised thresholds, rugs,
Lack of bathroom rails, grab bars or
slippery or uneven surfaces.
Improper use of a walking aid.
Eyeglasses with multifocal lenses.
Extrinsic Risk Factors
8. Complications of Falls
Soft tissue injuries.
Fractures (Hip, Femur, Humerus, Wrist).
Impaired mobility due to physical injury.
Impaired mobility from fear, loss of self-
Increased rate of nursing home placement.
Increased risk of death.
9. At present, no one screening test can be
recommended to identify potential fallers.
The two best predictors of falls are a
history of falls and a reported
abnormality in gait or balance.
Once a year, ask older people routinely:
– Have you had any falls in the last year?
– Have you noticed any problems with
gait, balance, or mobility?
Answering “yes” to either screening
question warrants further assessment.
Perform a simple gait assessment.
10. FALLS ASSESSMENT
Falls assessment should include a
multifactorial evaluation beginning
the circumstances surrounding the
risk factor assessment.
If available, information should be
obtained from a caregiver or witness.
11. FALLS Assessment
History of fall circumstances.
(lightheadedness, dizziness, loss of
Review of chronic medical problems
including alcohol misuse.
The environment in which the falls
occurred (loose mats, cords,
unstable furniture, lighting levels).
– vision and hearing.
– gait and balance (get up and go test).
– neurologic examination
(proprioception, muscle strength,
coordination, and cognition).
– cardiovascular system (rate and
rhythm, murmurs, orthostatic
Investigations (FBC, Blood sugar,
ECG, Echo, Holter, CT, MRI).
13. Get up and Go Test
Observe the patient conduct:
– the needs to push off the chair to arise.
– rock back-and-forth several times to arise.
– leg strength is diminished.
– gait abnormalities (poor step height or
– poor balance (wide-based stance and slow,
Those who are unsteady or take >15 seconds
to complete this task considered to be at
increased risk for future falls and require
referral to physical therapy for complete
14. Results of the evaluation will guide
Most patients needing intervention
will have multiple risk factors.
Multifactorial intervention is more
effective than single intervention in
preventing future falls.
Ensure that trained professionals
conduct the falls prevention program.
Treat those at high risk of recurrent falls
Refer to physiotherapy for muscle
strengthening, gait and balance
training and advice on use of assistive
Encourage increased exercise (such as
walking) or refer to an exercise
program with a balance component,
Tai Chi Chuan exercise.
Step mat exergame.
16. Step mat exergame
It is in a training intervention, in
which participants must make
quick and accurate steps in
response to target stimuli
presented on a screen.
Evidence indicates that it can
improve physical and cognitive
factors associated with falls in
Elderly after fall
Elicit a fall-focused history.
Review medications and reduce
those likely to cause falls.
Modification of home
Review past medical history.
Assess vision and refer if
21. Medication classes have a
higher potential to cause falls
22. Home Environmental Hazards
Old, unstable, and low-lying
Beds and toilets of inappropriate
Unavailability of grab bars
Uneven or poorly demarcated stairs
and inadequate railing
Throw rugs, frayed carpets, cords,
Slippery floors and bathtubs
Inadequate lighting, glare
Cracked and uneven sidewalks
Pets that get under foot