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ELDERLY FALL PREVENTION
Screening (continued)
A comprehensive fall evaluation includes a medical evaluation for comorbid conditions that place the patient at risk and an evaluation by a physical therapist. (Comprehensive evaluation and management for frailty and fall risk)The medical exam should evaluate neuromuscular strength and tone, sensation, joint function, proprioception, foot disabilities, peripheral neuropathy, and flexibility. The “Timed Up and Go” test asks the patient to get up as quickly and safely as possible, walk 10 feet, turn, walk back, and sit down. A person that takes longer than 14 seconds is at increased risk for a fall. There are multiple other test described in this paper that can be used to evaluate mobility. Additionally patients should be examined for visual acuity, postural blood pressure, balance, cognitive function, carotid sinus studies for carotid sinus hypersensitivity, and symptoms of depression. The physical therapist typically evaluates balance abilities, environmental conditions, neuromuscular status, and functional mobility assessment. A home evaluation should be included in a comprehensive fall evaluation.
A final portion of a comprehensive fall evaluation may include either of two tools used to evaluate “fear of falling,” the Tinnetti Falls Efficacy Scale and the Activities-specific Balance Confidence Scale. “Fear of falling” leads to restriction in activities even among those who have not experienced a fall and is a predictor of future mobility problems; it may be expressed a concern regarding balance.
If a fall or near-fall (stumble, loss of balance) has occurred the circumstances should be evaluated carefully. The authors of “Impaired Muscle and Mobility: The Road From Menopause to Frailty” [6] list the following fall circumstances with possible explanations:
- Rising suddenly – consider orthostatic hypotension
- Loss of consciousness – consider syncope or seizure
- Asymmetric weakness – consider cerebrovascular disease
- Chest pain – consider myocardial infarction or angina
- Drop attack – consider vertebrobasilar insufficiency
- Looking up or sideways – consider carotid sinus compression
- Slip or trip – consider environmental hazard, gait, balance, or vision problem
The most effective intervention programs have been multi-factorial, addressing co-morbid conditions, environmental hazards, polypharmacy issues, gait training, assistive devices and exercise. Exercise that focuses on strength, balance, and endurance has been shown to independently reduce falls and also helps people with a fear of falling. Environmental changes may include use of bath mats, removal of rugs, using night lights, adding rails to bathrooms and stairs, and moving electrical cords.
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