Notes

Assessment of Falls in the Elderly
When a patient falls, an individualized assessment and appropriate management will reduce the likelihood of future incidents. Controlled studies have demonstrated that a multifaceted program including a home evaluation by a geriatrician, medications review and occupational therapy to identify environmental hazards has been shown to be effective.

Patients who fall are at greater risk for hospitalization and institutionalization. This is a very serious problem.

History

Falls in older adults are common and often result in injury. They can lead to a loss of independence and may have serious individual and socioeconomic consequences. The incidence of fall-related injuries is increasing and could reach epidemic proportions if not prevented.

They are caused by intrinsic (age-related decline in function, some chronic and acute disorders, and adverse drug effects) and situational factors (e.g., rushing to the bathroom).

A patient's frailty index is a better predictor of hospitalization and death after a fall than age. Patients with a high risk factor need to have a customized care plan that addresses their specific risk. This includes a physical examination, a careful history, and laboratory tests.
Physical Examination

Observation and clinical judgement are important parts of the physical examination. The five times sit to stand test and other maneuvers that evaluate ambulation, transfer ability, and balance provide important information about the patient.

The person’s perception of his or her fall is also important. This can help identify underlying fall etiologies. A visual re-creation of the situational context can assist with this. In this way, a more targeted approach to care can be implemented. This can reduce fall incidences and the costs associated with them. It can also enhance healthcare providers’ understanding of the different types of treatable falls in this population. This, in turn, helps to best target interventions to prevent future falls.
Laboratory Tests

When a loved one falls, it's important to make sure they get a complete evaluation. It can uncover issues that are causing or making the falls more likely. These issues can range from simple bruising to broken bones and head injuries. Blood tests are generally standard after a fall. These can include a check of the patient's sodium, electrolytes and hemoglobin levels.

They should also ask about the medication the patient is taking, as certain drugs increase falling risk. The doctor should also take the patient's sitting and standing blood pressure to look for changes in blood pressure that could cause dizziness or lightheadedness. The timed up-and-go test is also useful in assessing gait problems.
Electrocardiogram (EKG)

Fall-related injuries are a major cause of hospitalization in patients >= 65 years and can lead to hip fractures, head trauma, internal and external injuries. fall alarm for elderly Patients who survive their falls can suffer from reduced quality of life and loss of independence.

In an EKG test, your healthcare provider puts electrodes (sticky patches with metal conductors) on your chest and arms. These send information through wires to a machine that prints out a graph of the electrical activity of your heart.

You may also have an exercise EKG test that measures the electrical activity of your heart while you are physically active. This is sometimes used to evaluate the effectiveness of medications that treat heart conditions.
Neurological Tests

Fall-related injuries are a significant burden on the elderly population. Every 11 seconds a senior is treated in the emergency room for a fall; every 19 minutes a senior dies from a fall.

Physicians should be alert to signs of recurrent falls, such as unexplained bruises, changes in cognition or personality, fear of falling and a general sense that the patient is becoming more vulnerable.

A comprehensive physical examination should be performed, including measurements of vital signs, blood pressure with patients supine and standing for 1 and 3 minutes to identify orthostatic hypotension and heart palpitations. Patients should be weighed, and a visual exam should be performed. Patients should be given specific information on reducing the risk of future falls.
Electromyography (EMG)

Electrodes placed on the surface of your skin detect the electrical activity of muscles at rest and during contraction. This information helps your provider diagnose issues that affect the nerves that connect to your muscles, such as carpal tunnel syndrome or myasthenia gravis.

You may have pain or discomfort during this test from the needle electrodes. You may also develop a bruise where the needles are placed, but these symptoms usually fade within a few days. You don’t need to fast before this test, and you should bathe before the test to remove any oil from your skin. You may also need to change into a hospital gown.
Blood Analysis

Although a doctor usually checks for injuries after a fall, few physicians specifically look at the possibility of other unanticipated physiologic falls that result from temporary changes in physical or cognitive function or unfamiliar surroundings. The USPSTF recommends checking sitting and standing blood pressure, assessing gait and balance, and looking for symptoms such as low energy, delirium or confusion, and pain in the feet, ankles, and hips that may contribute to a fall.

The USPSTF also recommends looking for a history of falling, a history of a serious fall, sarcopenia (loss of muscle strength), vision problems, a history of episodes of hypoglycemia or hyperglycemia, and a list of medications including sedatives and tranquilizers that can increase the risk for falls.
Imaging Tests

There are several diagnostic balance tests available to assess fall risk, including the Timed Up and Go test (TUG) which asks a patient to rise from a chair, walk for three meters (10 feet), turn, and return to a seated position in the chair in 12 seconds. Other tests include the Functional Reach test and Single Leg Stance test.

However, patients are often reluctant to report falls because they believe that falling is a normal part of the aging process or fear being restricted in their activities or institutionalized. Thus, most falls are underreported. The most effective approach to preventing falls is a thorough history and physical examination, looking for both intrinsic and extrinsic fall risk factors.

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