Falls in the elderly: an underestimated hazard - abstract

ABSTRACT

Accidents constitute the sixth leading cause of death in the elderly American population, and falls account for two-thirds of these accidental deaths. Although most falls in the elderly do not cause injury, some result in severe consequences. Hip fractures alone occur in approximatley 200,000 older Americans each year leading to significant morbidity and mortality, and resulting in a staggering cost to society. A fall is a marker of homeostatic dysfunction which is due to interaction of intrinsic and extrinsic factors. Intrinsic factors include age-related physiological changes, various disease processes, psychological problems and medication usage. Extrinsic factors are environmental hazards such as slippery floors, inadequate lighting and loose rugs. The majority of falls are multifactorial origin. A "premonitory fall" may be the presenting event of an impending illness such as a myocardial infarction, major infection, gastro-intestinal haemorrhage or stroke. Medication usage is an important contributor to falls. Centrally acting drugs such as tranquilizers, hypnotics and antidepressants are associated with increased risk of injury from falling. Other classes of implicated drugs include diuretics, antiarrhythmics, antihypertensives and hypoglycaemic agents. Fall prevention requires a multifaceted approach aimed at identification and amelioration of modifiable risk factors, improvement of balance, gait and muscle strength, use of assistive devices, exercise of adaptive behaviours and elimination of environmental hazards. Iatrogenic causes may be minimized by reduction of polypharmacy, awareness of the modified pharmacokinetics and pharmacodynamics of drugs in the elderly and careful consideration of benefit versus risk of medication usage (AU)