Falls
What are falls?
Physical injury
Fracture: In particular the neck of the femur (Hyndman et al. 2002). The incidence of fracture as a result of a fall is between 0.6% and 8.5% (Teasell et al. 2002). In cerebrovascular accident (CVA) the most common fracture is of the hip (45–59%) on the affected side (Dennis et al. 2002).
Soft tissue injuries: Include bruises and open wounds (risk of infection) (Hyndman et al. 2002).
Psychosocial impact
Fear of further falls: Lack of confidence often leads to activity avoidance, greater disability, lack of independence and social isolation (Hyndman et al. 2002; Mackintosh et al. 2005). Activity avoidance also has many secondary consequences which perpetuate the chance of a fall, e.g. reduced exercise tolerance, impaired balance responses, altered body schema, depressed mood and loss of bone mineral density (osteoporosis).
The aim of The National Service Framework for older people (Standard 6 – Falls) (NSF 2001) is to reduce the number of falls which result in serious injury and ensure effective treatment and rehabilitation for those who have fallen. In order to achieve this, preventive intervention and curative rehabilitation are viewed as equally important and therefore an assessment of the relevant risk factors is essential.
Risk factors for falling
The main points will be drawn out here, however for a more comprehensive understanding of this area the reader is referred to the NSF (2001) and The National Institute for Clinical Excellence guidelines for the assessment and treatment of falls in the older person (NICE 2004). Fall-related risk factors for the elderly are generally classified into intrinsic and extrinsic.
Intrinsic
• Mobility problems: Walking speed, balance (Mackintosh et al. 2006), lower limb muscle strength
• Cognitive factors: Poor attention (Anstey et al. 2006), depression
• Impaired vision: Impaired depth perception strongest risk factor for multiple falls (Lord and Dayhew 2001)
• Taking four or more medications
• Osteoporosis (loss of bone mineral density): Increases the risk of fracture
Pathology specific risk factors
CVA
• Various motor dysfunctions: (Yates et al. 2002)
• Altered sensation: (Yates et al. 2002; Soyuer and Ozturk 2007)
• Cognitive deficits: (Stapleton et al. 2001; Yates et al. 2002), including attention deficits (Hyndman and Ashburn 2003) and depressed mood (Ugur et al. 2000)
• Impaired balance: (Stapleton et al. 2001; Teasell et al. 2002)
• More dependency in activities of daily living (ADLs): (Lamb et al. 2003; Hyndman et al. 2003)
Predictive risk factors for falls in CVA
• Fear of falling – Previous falls: Error in perceived stability limits (Takatori et al. 2009)
• Although altered gait and balance are risk factors for falls they are not accurate in terms of predicting falls (Harris et al. 2005)
• ADLs: Patients who are more dependent are more likely to fall (Teasell 2002).
