Falls In Elderly – Know The Causes & Its Assessment

Overview

Falls are extremely common in elderly population and is a major contributor to morbidity and even mortality in this group. The cause of falls is often interplay of multiple factors from various diseases.

Causes Of Falls In Elderly

  • Postural Hypotension – There is a significant drop in blood pressure on standing resulting in loss of consciousness and fall.
  • Cardiac Arrhythmias – The heart may beat too slow, or cease to beat for a few seconds due to electrical abnormality resulting in loss of consciousness and fall.
  • Heart Valve Diseases – Diseases related to aortic valve causing a narrowing of its outlet results in difficulty for the heart to pump blood out and therefore result in loss of consciousness and fall.
  • Carotid Sinus Hypersensitivity – A pair of receptors exist in the neck in close relation to carotid artery which affects our blood pressure and heart rate. Disorders in these receptors may lead to sudden and catastrophic fall in blood pressure or sudden drop in heart rate leading to loss of consciousness or fall. A typical history is often of sudden neck movements precipitating falls.
  • Vasovagal Syncope or Benign Faint – These are simple faints which are extremely common in the elderly, but also in young adolescent children especially females. Certain conditions like prolonged standing, extreme heat (like blowing of hot air onto face from blower or a hot shower), heavy meal, vomiting, passing urine or stool can lead to an abnormal adjustment made by receptors on blood vessel wall. This causes sudden and significant drop in blood pressure resulting in loss of consciousness and fall.
  • Peripheral Neuropathy – Disorders of the peripheral nerves in leg may result in loss of communication between these nerves and the brain resulting in loss of balance and fall.
  • Stroke – Stroke especially in the back of the brain may cause loss of balance and fall.
  • Arthritis – This will weaken the joints and the muscles that stabilise the joint. This may result in postural instability and fall.
  • Incontinence and Urgency – Elderly patients often hurry to get to the toilet due to fear of incontinence. This is particularly dangerous at night in the dark. This results in many falls and fractures.
  • Any acute illness in elderly precipitating delirium can be a cause of falls.

Assessment Of Falls In Elderly

  • Full clinical examination including gait. Look out for cardiac valve disorders, peripheral neuropathy, joint deformity and muscle weakness due to arthritis.
  • Measure BP in lying position and after 1, 3 and 5 minutes standing.
  • ECG
  • Holter monitoring
  • Tilt table test and carotid sinus massage can be useful in diagnosis of vasovagal syncope and carotid sinus hypersensitivity.
  • Assessment of continence and symptoms related to prostate gland.
  • Blood tests: Includes calcium, vitamin D levels, thyroid function, vitamin B12 levels.

 

There isn’t a specific management strategy for falls. The management depends on the specific cause identified. Once an underlying medical disease is identified with the above tests treatment should be aimed at the underlying cause.

At the same time physiotherapy aiming to improve muscle strength and joint position and balance should be implemented.

A set of exercises called “Strength and balance training” is available which aims to improve muscle strength and stability around joints and reduces falls.

 

Dr. Dwaipayan Sen


FRCP(Glasgow) MRCP Geriatrics

Dr. Dwaipayan Sen is a Consultant Stroke Physician and Clinical Lead for Comprehensive Stroke Services (Salford Hope Hospital, UK)

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