Revision as of 11:19, 13 October 2023 (edit)104.239.124.130 (talk)← Older edit Revision as of 17:02, 22 November 2023 (edit) (undo)38.154.206.209 (talk) Newer edit → Line 1: Line 1: −When a patient falls, an individualized assessment and appropriate management will reduce the likelihood of future incidents. Controlled studies have demonstrated that a multifaceted program including a home evaluation by a geriatrician, medications review and occupational therapy to identify environmental hazards has been shown to be effective.<br /><br />Patients who fall are at greater risk for hospitalization and institutionalization. This is a very serious problem.<br /><br />History<br /><br />Falls in older adults are common and often result in injury. They can lead to a loss of independence and may have serious individual and socioeconomic consequences. The incidence of fall-related injuries is increasing and could reach epidemic proportions if not prevented.<br /><br />They are caused by intrinsic (age-related decline in function, some chronic and acute disorders, and adverse drug effects) and situational factors (e.g., rushing to the bathroom).<br /><br />A patient's frailty index is a better predictor of hospitalization and death after a fall than age. Patients with a high risk factor need to have a customized care plan that addresses their specific risk. This includes a physical examination, a careful history, and laboratory tests.<br /><br />Physical Examination<br /><br />Observation and clinical judgement are important parts of the physical examination. The five times sit to stand test and other maneuvers that evaluate ambulation, transfer ability, and balance provide important information about the patient.<br /><br />The person’s perception of his or her fall is also important. This can help identify underlying fall etiologies. A visual re-creation of the situational context can assist with this. In this way, a more targeted approach to care can be implemented. This can reduce fall incidences and the costs associated with them. [https://personalmedicalalarms.com.au/ personal alarms AU] It can also enhance healthcare providers’ understanding of the different types of treatable falls in this population. This, in turn, helps to best target interventions to prevent future falls.<br /><br />Laboratory Tests<br /><br />When a loved one falls, it's important to make sure they get a complete evaluation. It can uncover issues that are causing or making the falls more likely. These issues can range from simple bruising to broken bones and head injuries. Blood tests are generally standard after a fall. These can include a check of the patient's sodium, electrolytes and hemoglobin levels.<br /><br />They should also ask about the medication the patient is taking, as certain drugs increase falling risk. The doctor should also take the patient's sitting and standing blood pressure to look for changes in blood pressure that could cause dizziness or lightheadedness. The timed up-and-go test is also useful in assessing gait problems.<br /><br />Electrocardiogram (EKG)<br /><br />Fall-related injuries are a major cause of hospitalization in patients >= 65 years and can lead to hip fractures, head trauma, internal and external injuries. Patients who survive their falls can suffer from reduced quality of life and loss of independence.<br /><br />In an EKG test, your healthcare provider puts electrodes (sticky patches with metal conductors) on your chest and arms. These send information through wires to a machine that prints out a graph of the electrical activity of your heart.<br /><br />You may also have an exercise EKG test that measures the electrical activity of your heart while you are physically active. This is sometimes used to evaluate the effectiveness of medications that treat heart conditions.<br /><br />Neurological Tests<br /><br />Fall-related injuries are a significant burden on the elderly population. Every 11 seconds a senior is treated in the emergency room for a fall; every 19 minutes a senior dies from a fall.<br /><br />Physicians should be alert to signs of recurrent falls, such as unexplained bruises, changes in cognition or personality, fear of falling and a general sense that the patient is becoming more vulnerable.<br /><br />A comprehensive physical examination should be performed, including measurements of vital signs, blood pressure with patients supine and standing for 1 and 3 minutes to identify orthostatic hypotension and heart palpitations. Patients should be weighed, and a visual exam should be performed. Patients should be given specific information on reducing the risk of future falls.<br /><br />Electromyography (EMG)<br /><br />Electrodes placed on the surface of your skin detect the electrical activity of muscles at rest and during contraction. This information helps your provider diagnose issues that affect the nerves that connect to your muscles, such as carpal tunnel syndrome or myasthenia gravis.<br /><br />You may have pain or discomfort during this test from the needle electrodes. You may also develop a bruise where the needles are placed, but these symptoms usually fade within a few days. You don’t need to fast before this test, and you should bathe before the test to remove any oil from your skin. You may also need to change into a hospital gown.<br /><br />Blood Analysis<br /><br />Although a doctor usually checks for injuries after a fall, few physicians specifically look at the possibility of other unanticipated physiologic falls that result from temporary changes in physical or cognitive function or unfamiliar surroundings. The USPSTF recommends checking sitting and standing blood pressure, assessing gait and balance, and looking for symptoms such as low energy, delirium or confusion, and pain in the feet, ankles, and hips that may contribute to a fall.<br /><br />The USPSTF also recommends looking for a history of falling, a history of a serious fall, sarcopenia (loss of muscle strength), vision problems, a history of episodes of hypoglycemia or hyperglycemia, and a list of medications including sedatives and tranquilizers that can increase the risk for falls.<br /><br />Imaging Tests<br /><br />There are several diagnostic balance tests available to assess fall risk, including the Timed Up and Go test (TUG) which asks a patient to rise from a chair, walk for three meters (10 feet), turn, and return to a seated position in the chair in 12 seconds. Other tests include the Functional Reach test and Single Leg Stance test.<br /><br />However, patients are often reluctant to report falls because they believe that falling is a normal part of the aging process or fear being restricted in their activities or institutionalized. Thus, most falls are underreported. The most effective approach to preventing falls is a thorough history and physical examination, looking for both intrinsic and extrinsic fall risk factors.+Falls in older adults can result in severe injuries. A simple screen can identify individuals who need a more comprehensive multifactorial assessment of their fall risk factors.<br /><br />Patients often do not report falling due to fear of losing their independence and stigma associated with the condition. However, unexplained bruises, a history of syncope or other signs indicate a need for further evaluation.<br /><br />Physical Examination<br /><br />When assessing patients for fall risk it is important to use a physical exam. This should include evaluation of balance, joint range of motion and muscle strength. Using validated assessment tools such as the Timed Get-Up and Go test or Berg Balance Scale allows physicians to compare results between patients.<br /><br />A targeted history and physical examination that includes asking about past falls is also essential. [https://personalmedicalalarm.com/ Personal medical alarms] This should elicit information about the severity of the fall and any injuries that resulted. This will help identify patients who are at high risk of future falls.<br /><br />The physical exam should include a 30-second chair stand test, four stage balance tests and a gait analysis. These tests will determine if there is any difficulty with standing from a chair, walking and carrying objects. The physician should also be aware of any medications that could increase the risk of falling (eg. diuretics) and assess for orthostatic hypotension. The patient should be encouraged to participate in a program of exercise that has been shown to reduce falls.<br /><br />Medical History<br /><br />Patients with a history of fall should be evaluated by clinicians and underlying risk factors addressed. Falls result in significant morbidity and mortality, especially among older adults. Patients who have fallen are at increased risk of future falls and serious injury, including hip fractures.<br /><br />A detailed patient history should be obtained, focusing on the when, where and why of the last fall. The physician should also inquire about the frequency of falling and mobility problems. An objective assessment of mobility can be made with a simple timed up and go (TUG) test, which involves measuring the amount of time it takes for the patient to rise from a chair, walk 10 feet, turn, sit down, and return to the original position.<br /><br />The physical examination should include a review of medications, measurement of blood pressure on both supine and standing, auscultation of the heart to detect signs of valvular disease, and an evaluation for a visual and balance abnormality. Generally, the patient should be referred to a geriatrician and/or a cardiologist for further evaluation. Frequently falling older adults can be managed with multifactorial assessment and interventions such as medication management, environmental modifications, geriatric counseling, physical therapy or occupational therapy, education and dietary/nutritional modification.<br /><br />Behavioral Assessment<br /><br />A person with a history of falling can be at risk for many complications. Serious injuries, such as hip fracture, can be fatal in up to 25% of cases and cause permanent loss of mobility and independence. Long-term consequences can include a decline in function, inability to return home, and nursing-home placement.<br /><br />A targeted history and physical examination addressing potential home hazards, medications (including over-the-counter and prescription medications), cognitive and visual impairment, functional limitations, orthostatic hypotension, and gait and balance abnormalities can help identify fall risk factors. Numerous interventions (single and multicomponent) have been shown to decrease falls.<br /><br />A behavioral assessment can provide useful information on the patient's ability to change their behaviors to reduce fall risk. It can include a motivational interview with a pharmacist who preforms a review of all a patient's medications and asks open-ended questions about their use and attitudes toward the medication and a physical therapist performing a timed up and go test as well as a standardized balance/gait assessment. Research shows that implementing these interventions decreases falls-related and all-cause ED re-visits, hospital admissions, and acuity of care.<br /><br />Medications<br /><br />Falling is a major cause of injury in older adults. Complications from falls can be serious and can include hip fractures. It is important to identify the underlying cause(s) of falls. A thorough physical examination should be performed and all relevant medications reviewed. In addition, temperature should be checked to determine whether a recent fever may have been a contributing factor. Heart rate and rhythm should be assessed to detect obvious bradycardia or resting tachycardia and auscultation should be done to rule out valvular heart disease. Vision should be evaluated and a referral to an eye care provider made if necessary.<br /><br />A standardized assessment tool has been developed to help health professionals isolate specific risk factors that are amenable to intervention. Older patients who report a history of falling and have a gait or balance problem on the Get-Up-and-Go Test should be considered high risk and should be offered general information about how to reduce their risks of future falls. These patients can be offered an exercise program such as tai chi or the Otago Exercise Programme that has been shown to be effective in reducing falls in people who are at low or moderate risk.<br /><br />Environmental Assessment<br /><br />In some circumstances the environment where a person lives or is being treated may be the cause of their falls. This could include a hazard such as a loose step or poor lighting or it could be their living arrangements such as crowded housing and lack of personal space. Fall risk factors can also be caused by activities and decisions such as walking while distracted or rushing to the toilet.<br /><br />Falling can have a profound effect on a patient’s quality of life. Aside from the physical injuries that can occur falling also reduces confidence, causes activity restriction and limits social interaction. It can also lead to dependence on carers which puts strain on family and friends.<br /><br />A comprehensive fall risk assessment will identify the patients who have a high falls risk and further evaluation is required – eg the Morse Fall Scale or Humpty Dumpty Falls Assessment Tool (HDFA). These assessments should be conducted by trained health care professionals. They should also include a review of medications and the possibility that they may be contributing to falls by increasing the likelihood of dizziness or drowsiness. Revision as of 17:02, 22 November 2023 Falls in older adults can result in severe injuries. A simple screen can identify individuals who need a more comprehensive multifactorial assessment of their fall risk factors.Patients often do not report falling due to fear of losing their independence and stigma associated with the condition. However, unexplained bruises, a history of syncope or other signs indicate a need for further evaluation.Physical ExaminationWhen assessing patients for fall risk it is important to use a physical exam. This should include evaluation of balance, joint range of motion and muscle strength. Using validated assessment tools such as the Timed Get-Up and Go test or Berg Balance Scale allows physicians to compare results between patients.A targeted history and physical examination that includes asking about past falls is also essential. Personal medical alarms This should elicit information about the severity of the fall and any injuries that resulted. This will help identify patients who are at high risk of future falls.The physical exam should include a 30-second chair stand test, four stage balance tests and a gait analysis. These tests will determine if there is any difficulty with standing from a chair, walking and carrying objects. The physician should also be aware of any medications that could increase the risk of falling (eg. diuretics) and assess for orthostatic hypotension. The patient should be encouraged to participate in a program of exercise that has been shown to reduce falls.Medical HistoryPatients with a history of fall should be evaluated by clinicians and underlying risk factors addressed. Falls result in significant morbidity and mortality, especially among older adults. Patients who have fallen are at increased risk of future falls and serious injury, including hip fractures.A detailed patient history should be obtained, focusing on the when, where and why of the last fall. The physician should also inquire about the frequency of falling and mobility problems. An objective assessment of mobility can be made with a simple timed up and go (TUG) test, which involves measuring the amount of time it takes for the patient to rise from a chair, walk 10 feet, turn, sit down, and return to the original position.The physical examination should include a review of medications, measurement of blood pressure on both supine and standing, auscultation of the heart to detect signs of valvular disease, and an evaluation for a visual and balance abnormality. Generally, the patient should be referred to a geriatrician and/or a cardiologist for further evaluation. Frequently falling older adults can be managed with multifactorial assessment and interventions such as medication management, environmental modifications, geriatric counseling, physical therapy or occupational therapy, education and dietary/nutritional modification.Behavioral AssessmentA person with a history of falling can be at risk for many complications. Serious injuries, such as hip fracture, can be fatal in up to 25% of cases and cause permanent loss of mobility and independence. Long-term consequences can include a decline in function, inability to return home, and nursing-home placement.A targeted history and physical examination addressing potential home hazards, medications (including over-the-counter and prescription medications), cognitive and visual impairment, functional limitations, orthostatic hypotension, and gait and balance abnormalities can help identify fall risk factors. Numerous interventions (single and multicomponent) have been shown to decrease falls.A behavioral assessment can provide useful information on the patient's ability to change their behaviors to reduce fall risk. It can include a motivational interview with a pharmacist who preforms a review of all a patient's medications and asks open-ended questions about their use and attitudes toward the medication and a physical therapist performing a timed up and go test as well as a standardized balance/gait assessment. Research shows that implementing these interventions decreases falls-related and all-cause ED re-visits, hospital admissions, and acuity of care.MedicationsFalling is a major cause of injury in older adults. Complications from falls can be serious and can include hip fractures. It is important to identify the underlying cause(s) of falls. A thorough physical examination should be performed and all relevant medications reviewed. In addition, temperature should be checked to determine whether a recent fever may have been a contributing factor. Heart rate and rhythm should be assessed to detect obvious bradycardia or resting tachycardia and auscultation should be done to rule out valvular heart disease. Vision should be evaluated and a referral to an eye care provider made if necessary.A standardized assessment tool has been developed to help health professionals isolate specific risk factors that are amenable to intervention. Older patients who report a history of falling and have a gait or balance problem on the Get-Up-and-Go Test should be considered high risk and should be offered general information about how to reduce their risks of future falls. These patients can be offered an exercise program such as tai chi or the Otago Exercise Programme that has been shown to be effective in reducing falls in people who are at low or moderate risk.Environmental AssessmentIn some circumstances the environment where a person lives or is being treated may be the cause of their falls. This could include a hazard such as a loose step or poor lighting or it could be their living arrangements such as crowded housing and lack of personal space. Fall risk factors can also be caused by activities and decisions such as walking while distracted or rushing to the toilet.Falling can have a profound effect on a patient’s quality of life. Aside from the physical injuries that can occur falling also reduces confidence, causes activity restriction and limits social interaction. It can also lead to dependence on carers which puts strain on family and friends.A comprehensive fall risk assessment will identify the patients who have a high falls risk and further evaluation is required – eg the Morse Fall Scale or Humpty Dumpty Falls Assessment Tool (HDFA). These assessments should be conducted by trained health care professionals. They should also include a review of medications and the possibility that they may be contributing to falls by increasing the likelihood of dizziness or drowsiness.