I know there’s still a week and a half of my GP placement left to go, but I’ve started thinking ahead in an attempt to learn a bit about geriatric medicine and save myself (some) embarrassment when my geriatrics placement starts. I recently read that falls cause a whopping 60% of hospital admissions for fractures, and one third of these were patients over 80 years old. If you’re keen to know more, you can read the article containing these figures HERE. It’s probably no surprise that a large proportion of older patients admitted to hospital are as a result of falling, but these figures only include those admitted with fractures, and ignores all those who had falls but didn’t break anything so in fact the actual numbers will be higher still.
There are, as you might expect, LOADS of causes of falls in the elderly. I’ve found a great paper on the topic in the International Nursing Review that covers causes of falls, risk factors, taking a history of a patient who has had a fall amongst other things. Access it HERE and prepare to get better informed. Or you can read on, and be less well informed but still better off (unless you knew it all already).
CAUSES OF FALLS IN THE ELDERLY
Here are some causes of falls in older patients, divided into body systems, although the eagle eyed amongst you might spot a bit of overlap:
Visual impairment, vestibular dysfunction (eg vertigo), peripheral neuropathy, gait disturbances, seizure disorder (or the use of neuropleptics), cerebrovascular accident (stroke/TIA), parkinsonianism, cerebellar disorder.
Myocardial infarction, arrhythmias and syncope, postural hypotension
Arthritis, mechanical/gait abnormaility, “deconditioning” as a result of insufficient exercise.
Urinary tract infection, micturition syncope, nocturia
Medications (eg benzodiazepines, drugs used in hypertension treatment, neuroleptics etc. Polypharmacy also increases risk of falls in the community.)
Substance abuse (alcohol, drugs, OTC medications)
Environmental hazards, eg loose rugs, tiles, poor lighting, recent use of walking stick/frame, living alone.
I’m certain that this list is by no means exhaustive, but it gives you a good idea of the sorts of things you need to consider when presented with a patient with a history of falls. Following are a couple of tables reproduced from “Falls in the elderly: What can be done?” Akyol AD (2007), International Nursing Review 54, 191–19, that outline findings you might expect in a patient who has fallen, as well as cues for taking a falls history. Just remember “I HATE FALLING” and “CATASTROPHE”.