# 015  Fall Etiology and Assessment

Fast Facts and Concepts #015 PDF

Authors: Yana Thaker, Kathyrn Denson MD, Steven Denson MD, Bambi Wessel

Objectives

1. List 10 possible underlying etiologies that may contribute to falls in elderly patients.
2. Describe the assessment of falls, as outlined below in figure 1.
3. List 5 medical assessments (physical exam or lab studies) that may be done to further assess potential fall etiologies.

Context: Elderly patient fall (home, institution)

Action: Perform a “falls assessment” to determine possible contributing factors to patient falls when the etiology is not clear. Tripping without falling should also be evaluated as it helps to assess potential environmental risks. Repeated falls should be evaluated individually as they may have different etiologies. 

Incidence/Prevalence: A “fall” is defined as an unexpected change in position from one level to another lower level.  According to the CDC, 1/3 of adults aged 65 years and older fall annually. Falls are the leading cause of injury in the elderly and result in 18,000 deaths due to fall related injuries annually.

Underlying Science: The underlying science varies based on the etiology of the fall.  There are numerous possibilities that may be contributing. Examples include:

1. Diabetic neuropathy– Increased glycosylation of hemoglobin due to elevated plasma glucose levels may lead to neuronal cell damage and loss.
2. Anticholinergic medications– Inhibition of the cholinergic neurotransmitters in the brain has been shown to predispose patients to falls.

Potential Fall Etiologies:
 

Assessment:

ACGME Competencies Patient Care; Medical Knowledge
 

References:

1. Yvonne ML, Whitlock EP, Lin JS, Fu R, O'Connor EA, Gold R; US Preventive Services Task Force. Primary care-relevant interventions to prevent falling in older adults: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2010 Dec 21; 153(12):815-25.
2. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. Guideline for the prevention of falls in older persons. J Am Geriatr Soc 2001; 49:664–672.
3. Fuller, G. F. Falls in the elderly. Am Fam Physician. 2000 Apr 1; 61(7):2159-2168.
    

Author Affiliation: Medical College of Wisconsin, Milwaukee, Wisconsin.

Geriatric Fast Facts are edited by the faculty of the Geriatric Education Teams (GETS) program funded by the Reynolds Foundation, Kathryn Denson, MD, Steven Denson, MD, & Edmund Duthie, MD from the Division of Geriatrics, Medical College of Wisconsin, and are published by the Geriatric Fast Facts Website at the Medical College of Wisconsin. For more information write Kathryn Denson, MD. More information, as well as the complete set of Fast Facts, available at www.mcw.edu/Geriatric-Fast-Facts.htm

Copyright/Referencing Information: Users are free to download and distribute Geriatric Fast Facts for educational purposes only. Citation: Yana Thaker, Kathyrn Denson MD, Steven Denson MD, Bambi Wessel, Fast Fact #15: Fall Etiology and Assessment, February 2012

Geriatric Fast Facts, available at www.mcw.edu/Geriatric-Fast-Facts.htm

Disclaimer: Geriatric Fast Facts provide educational information. This information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Geriatric Fast Facts cite the use of a product in a dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.