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Importance of screening for risk of falls

Introduction

A fall is defined as an event when a person unintentionally  comes to rest on the ground or  a lower level  other than consequence of sustaining a violent blow, loss of consciousness, sudden onset of paralysis as in a stroke or seizure.

Epidemiology of fall

Falls are common among the older persons. Studies from other countries reported 30 % to 40% of older persons aged 65 years old and above in the community had one or more falls in the previous 12 months. A fifth sustained injury secondary to their falls. About 40% to 50% of residents of institutions fall each year. In a study done in a primary- care clinic in Malaysia, the prevalence of falls among the older persons was 47%.

Importance of screening for risk of fall

Screening for risk of fall is very important in elderly to prevent future fall and its consequences. The importance of screening for risk of fall in elderly includes:

  • Fall is a major cause of injury and trauma in the elderly.

  • The consequences of falls and fractures can lead to further functional decline in elderly.

  • Many falls and  injuries can be prevented and consequences minimized.

  • Most of elderly experienced recurrent falls and majority occurred in their homes. in the community, older persons who had fallen in past 12 months, 57%  fell again in the next 12 months and 31% had two or more falls. Thus, previous fall increases risk of future falls.

  • F alls often  go unrecognized by health care providers because screening for risk of falls is usually not included in the routine history and physical examination and many elderly who fall do n’ t always have an obvious injury.

  • Many elderly patients are reluctant to seek assistance because the injury was minimal and they attribute falling to the ageing process. In addition, the elderly also fear of being subsequently restricted in their activities or being institutionalized.

Consequences of falls

  • Falls related injury e.g. fracture (5%) and other serious injury (15%)

  • Immobility and increase dependency

  • Fear of falling

  • Anxiety and depression

  • Admission to institutional care

  • Major cause of disability and death in elderly

Factors affecting fall severity

  • Multiple system impairment e.g. muscle weakness post stroke can lead to less effective saving mechanism

  • Osteoporosis can lead to higher risk of fracture

  • Psychological effect leading to loss of confidence

  • Secondary injuries due to post fall immobility and half of older people cannot get up again after the fall

  • Prolonged post fall immobility can lead to

    • Muscle atrophy

    • Joints contracture

    • Pressure sores

    • Dehydration

    • Pneumonia

    • Deep vein thrombosis

    • Orthostatic hypotension

    • Osteoporosis

Conclusion

Falls could lead to significant morbidity and mortality in elderly, as well as affecting the quality of life of the older persons. In elderly, risks of falls are related to both intrinsic and extrinsic factors and majority are preventable. Therefore, screening could identify older persons with risk of falling and prevent future falls and its’ consequences.

References

  1. The prevention of falls in later life. A report of the Kellogg International Work Group on the Prevention of Falls by the Elderly. Dan Med Bull 1987;34 Suppl 4:1-24.

  2. Centers  for Disease Control and Prevention(CDC). Self reported falls  and falls at home among person more or equal 65 years-United States,2006. MMWR Morb Mortal Wkly Rep.2008:57:225-9.

  3. Sazlina SG, Krishnan R, Samsul AS, Zaiton A , Visvanathan R. Prevalence of falls among older people attending a primary care clinic in Kuala Lumpur Malaysia.  Malaysian Journal of Community Health (2008) Vol 14(1): 11-15.

  4. Ayse O, Hulya D, Nihal G, Mehtap O, Didem K. The relationship between risk factors for falling and the quality of life in older  BMC Public Health 2005, 5:90 doi:10.1186/1471-2458.

Last Review : 03 October 2013
Writer : Dr. Ho Bee Kiau