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What is the role of falls?

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There is now firm evidence to support interventions in the prevention of falls in older people, and emerging data support prevention of falls as a method of fracture prevention. This chapter discusses the epidemiology of falls, risk factors associated with an increased risk of falling, assessment of the older faller, and evidence-based approaches to the prevention of falls in the older person. Several randomized controlled trials have found that hip protectors, if worn, probably prevent hip fractures, but that poor compliance is a major issue limiting the effectiveness of this form of intervention. More data are needed to support the role of prevention of falls in preventing fractures, as well as comparative cost-effectiveness data with other evidence-based approaches to preventing fractures in an older population.

Section snippets

Incidence

One third of the population aged 65 years and above fall each year2, 3, rising to 50% of people aged 85 years and above.4 Of those who fall, 50% do so repeatedly.5 Older community-dwelling women experience significantly more falls than do older men3, and even after allowing for physical and social factors women are 1.5 times more likely to fall than men.6 Women living alone are at greater risk of falling and sustaining an injury.2 The incidence of falls and fall-related injuries in

Falls risk factors

Maintaining balance is a complex task involving many systems which are affected by ageing and susceptible to impairments induced by disease. There has been a great deal of research focusing on risk factors for falling, and over 400 potential risk factors have been proposed.17 Fall risk factors are generally considered to be either intrinsic (i.e. those pertaining to the physical and cognitive status of the individual) or extrinsic (i.e. environmental hazards or factors affecting the interface

Identification of people at risk of falls

Falls risk assessment is particularly important in older people with osteoporosis, as over 60% of older people with femoral neck osteoporosis have fall-related risk factors,29 and 90% of hip fractures result from a fall.30 It is therefore likely that an understanding of clinical falls risk factors when combined with biochemical and radiological indicators of bone density will improve the accuracy of predicting future fracture risk.

It is important to differentiate between measures used to simply

History

When trying to establish the cause of a fall it is important to remember that most falls occur as a result of an interaction between intrinsic and extrinsic factors and that multiple risk factors increase the risk of falls.35 There are many disease processes seen more commonly in the older population that contribute to an increased risk of falls mainly through impairing postural stability. Table 2 highlights some of the disease processes that impact on the ability to maintain balance.

A detailed

Interventions to prevent falls/fractures

There is now good evidence that falls can be prevented in older people in a variety of populations and clinical settings: community-dwelling populations, care-home residents, older people presenting to the Emergency Department with a fall, inpatients, and those being discharged home from hospital. Figure 2 identifies the different populations studied and whether single or multifaceted interventions have been shown to prevent falls in these populations. Both single50, 51, 52, 53, 54, 55, 56, 57

Summary

The complexity of the interaction between physiological variables, intrinsic disease and the external environment has often led to a nihilistic approach to the prevention of falls in older people and a view that falls are an inevitable consequence of ageing. However, there is now sound evidence to support the effectiveness of falls prevention programmes. Using assessments based on evidence-based risk factors amenable to correction, it is possible to identify and intervene in those most likely

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