The Rational Clinical Examination
David L. Simel, Drummond Rennie
Falls, Older Adults
David A. Ganz, Yeran Bao, Paul G. Shekelle, Laurence Z. Rubenstein
Multifactorial Evaluation of Patients at High Risk for Future Falls
Topics Discussed:
activities of daily living, aging, elderly fall, equilibrium, fall, gait, higher cerebral function, assessment and interpretation, orthostatic hypotension, visual impairment
Excerpt:
"A 76-year-old woman walks into your office unaided, without any
noticeable gait abnormality, but reports that she has balance problems.
Her daughter fills out an intake questionnaire at her mother's
new-patient evaluation; the patient's medication list includes
hydrochlorothiazide, glyburide, aspirin, and temazepam as needed
for sleep. The daughter hands you a bone densitometry report indicating
that the patient has osteoporosis of the femoral neck. Since most
osteoporotic hip fractures occur after a fall, you would like to
calculate your patient's risk of falling to decide whether
she needs specific interventions to prevent falls.One third of community-dwelling individuals older than 65 years
fall every year.1,2 Falls were the most common
mechanism of injury (62%) among an estimated 2.7 million
nonfatal injuries among those 65 years and older treated in United
States emergency departments in 2001,3 indicating
that falls are a serious medical and public health problem. Five
percent to 10% of falls cause serious injuries such as
major head trauma, major lacerations, or fracture.2 Falls,
and especially injurious falls, predict placement in a skilled nursing
facility.4..."
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