Sunday, May 16, 2010

Addressing Falls in Older Adults (Elise)

You've heard it a million times: falls can be devastating in the elderly population. "Fall Prevention" has a lot of buzz now in the healthcare industry because falls are so costly to the healthcare system. As a physical therapist, I have an important role in helping individuals recover function after falls, but moreso in identifying risk factors of persons who are at high risk for falling in the future.

There can be many different contributors to falls, which makes it a complex and challenging construct to assess in people. Think about it! Falls can be caused by: poor balance, gait deficits (including using an assistive device), muscle weakness, visual changes, polypharmacy (multiple medications), decreased cardiovascular function, neurologic deficits, depression, decreased cognitive capabilities, and fear (to name a few!). By carefully collecting information during the patient interview, as well as taking objective measurements during the PT evaluation, I can develop a treatment strategy to specifically target those areas that place individuals at risk for falls and future falls.

During a subjective interview with older patients, it is important to ask about "fall history" (if the patient has fallen in the past). If they have fallen, one must follow-up with questions:
--How many times they have fallen (one fall suggests an acute medical problem versus several falls suggests slow deterioration of balance ability)
--Where they have fallen (environment)
--What activity they were doing (multi-tasking? one-legged stance? reaching?)
--What time of day (at night when more tired? poor vision in dark?)

Remember-- the interview can help you to form a hypothesis for what can be contributing to falls, but your objective examination will provide you with important information, too. There are many body systems to consider: 1) Sensory systems (vision, vestibular (inner ear), and somatosensation (feet)); 2) Musculoskeletal systems (strength, range of motion, endurance); 3) Cognitive/Affective factors (fear of falling, depression, anxiety, medications)
In addition to these, an environmental assessment is helpful to determine hazards that exist (home/apartment, carpet/wooden floor, stairs, lighting, excess clutter). Also, consider the impact of family support on the person. Are they living alone and forced to be independent with activities that they really should not perform on their own? Or is a family member present to assist or prevent the person from taking "risky" action?

Can you see how much is involved in fall assessment?! In my next post, I will share a patient case with you involving a patient with multiple sclerosis who came to me with a long fall history-- and whose treatment program addressed many of the above issues in order to allow for safe and independent functioning at home and the community.

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