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CONSIDER: FALLS

DEFINITION

Fall: An unintentional change in position resulting in coming to rest on the ground or other lower level (Thapa, Borckman, Gideon, Fought & Ray, 1996).

ASSESSMENT/SCREENING/DIAGNOSIS

Atypical Presentation

Falls may be an atypical presentation (typical in frail older adults) of an underlying acute medical problem. Any fall should be evaluated for an underlying medical etiology (See table: Most Likely Underlying Cause of Falls). If a patient is found in acute distress: pain, difficulty breathing, excessive bleeding or presents with an acute change in memory or behavior, consider an unwitnessed fall as a potential underlying cause.

Most likely Underlying Cause of Falls
Cardiovascular causes

 

  • Arrhythmias
  • Orthostatic hypotension
  • Carotid blockage
  • Other cardiovascular diseases causing impaired cerebral perfusion
Psychological status

 

Musculosketal disorders

 

  • Osteoporosis
  • Myopathy
  • Degenerative joint disease
  • Trauma: fracture, sprain, ligament tear
Decline or change in function: change in ability to sit, stand, ambulate, toilet, transfer, or eat

Change in balance (sitting or standing); new onset dizziness or vertigo

Neurological Causes

 

  • Transient ischemic attack
  • Stroke
  • Parkinson's Disease
History of prior fractures

Orthostatic hypotension - determine underlying cause:

 

  • Medications
  • Infection
  • Dehydration
  • Underlying disease: e.g. cardiovascular, diabetes, Parkinson's
New onset bowel or bladder incontinence

New onset sensory impairment: change in vision, hearing, tactile sensation (neuropathy)

Dehydration suspected

 

  • Decline in fluid intake
  • Increased demand (e.g. infection, surgery)
  • Medications (diuretics)
Acute illness (See:Delirium Section)

 

  • Infection
  • Anemia/GI bleeding
  • Fluid & electrolyte imbalance
Use of restraints

Medications (See: Assessment for High Risk Mediciations in the Elderly)
Consider newly added drugs, polypharmacy, drug interactions:

 

  • Cardiovascular drugs
  • Diuretics
  • Antianxiety drugs
  • Medication that promote sleep
  • Antidepressants
  • Antihistamines
  • Pain medications

Reference

Thapa, P., Borckman, K., Gideon, P., Fought, R., & Ray, W. (1996). Injurious falls in risk nonambulatory nursing home residents: A comparative study of circumstances, incidences, and factors. Journal of the American Geriatrics Society, 44: 273-278.

 

Last updated - February 2005