Fall risk and function in older women after gynecologic surgery.

PURPOSE OF STUDY: To examine change in balance-related fall risk and daily functional abilities in the first 2 post-operative weeks and up to 6 weeks after gynecologic surgery. MATERIALS AND METHODS: Prospective cohort study in gynecologic surgery patients age 65 and older. Balance confidence (Activities-specific Balance Confidence Scale) and functional status (basic and instrumental activities of daily living) were recorded pre- and post-operatively daily for 1 week and twice the second week. Physical performance balance and functional mobility were measured pre- and 1 week post-operatively using the Tinetti Fall Risk Scale, Timed Up and Go, and 6-Minute Walk test. Measures were repeated 6 weeks after surgery. Non-parametric tests for paired data were used comparing scores baseline to post-operative (POD) 7 and to POD 42. RESULTS: Median age was 72 years (range 65-88). Fall risk was elevated during the first 2 post-operative weeks, greatest on the median discharge day, POD 2 (p<0.01). Balance performance and functional mobility at 1 week were significantly lower than baseline (p<0.01). Functional abilities declined, including new dependence in medication management at home in 22% of these independent and cognitively intact women. CONCLUSIONS: After gynecologic surgery, older women's fall risk is highest on POD 2 and remains elevated from baseline for 2 weeks. Functional limitations in the early home recovery period include the anticipated (bathing, cooking, etc.) and some unanticipated (medication management) ones. This information may help with post-operative discharge planning.

Impaired muscle and mobility: the road from menopause to frailty.

Older women should be screened for fall risk frequently. Falls are preventable and screening can be as simple as asking "Have you fallen in the past year?" combined with questioning about gait or balance problems if the patient has not experienced a recent fall. A simple physician screen can drive the need for a more comprehensive fall evaluation and the appropriateness of a multifactorial fall reduction program referral. This paper describes an algorithmic management approach to fall prevention in older women with impaired muscle and mobility; assisting them in navigating and mitigating adversity on the road from menopause to frailty.