Falls are common in elderly patients and are often multi-factorial. Risk factors must be minimised and all patients who fall frequently need multidisciplinary assessment by doctors/nurses, physiotherapists, occupational therapists and social services (in case more care is required). The differential diagnosis of falls is covered here.
Frequency of falls (in past 12 months)
Reason for falls, e.g. trip, unsteadiness, syncope
Bone protection: bisphosphonates, calcium, vitamin D(reduce fracture risk)
Social history and environment
Who they live with
Who performs their daily tasks (if the patient does them, how well?)
Mobility: baseline, mobility aids
Footwear: appropriately fitting?
Exercise: increases muscle strength, reduces frailty and falls risk
Home hazards: rugs, cables, furniture, wet floors, stairs, lighting
Examination – adapt depending on risk factors from history
General examination: frailty, myopathy, sarcopenia
Cognitive assessment: e.g. mini-mental state examination
Neurological examination: including gait, balance and signs of parkinsonism
Cardiovascular exam, postural BPs and ECG
Specific falls risk tests
Timed ‘up and go’ test: request that the patient rise from a chair without the support of their arms, walk 3 metres, then turn round and sit down again. A walking aid can be used if required. Completion of the test without unsteadiness or difficulty suggests a low risk of falling.
‘Turn 180°’ test: request that the patient stand up and turn around until they are facing the opposite direction. If more than four steps are required to do this, further assessment is indicated.
Physiotherapy and occupational therapy assessments
Summarise your findings and risk factors
Suggest how risk factors could be mitigated, for example:
Strength and balance training
Home hazard intervention (occupational therapy assessment)
Psychiatric assessment if evidence of cognitive impairment