Accidental fall: Difference between revisions

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An '''accidental fall''' is defined as a fall "due to slipping or tripping which results in injury".<ref>{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?mode=&term=Accidental+Falls&field=entry |title=Accidental Falls|author=National Library of Medicine |accessdate=2007-10-17 |format= |work=}}</ref>
An '''accidental fall''' is defined as a fall "due to slipping or tripping which results in injury".<ref>{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?mode=&term=Accidental+Falls&field=entry |title=Accidental Falls|author=National Library of Medicine |accessdate=2007-10-17 |format= |work=}}</ref>


===Falls in the elderly===
==Falls in the elderly==
At least a third of persons aged 65 years or more fall each year, with 10% leading to injury.<ref name="pmid12510042">{{cite journal |author=Tinetti ME |title=Clinical practice. Preventing falls in elderly persons |journal=N. Engl. J. Med. |volume=348 |issue=1 |pages=42–9 |year=2003 |pmid=12510042 |doi=10.1056/NEJMcp020719}}</ref>
At least a third of persons aged 65 years or more fall each year, with 10% leading to injury.<ref name="pmid12510042">{{cite journal |author=Tinetti ME |title=Clinical practice. Preventing falls in elderly persons |journal=N. Engl. J. Med. |volume=348 |issue=1 |pages=42–9 |year=2003 |pmid=12510042 |doi=10.1056/NEJMcp020719}}</ref>


====Assessing risk====
===Assessing risk===
The presence of various medical conditions and the results of functional tests can assess the risk of falling.<ref name="pmid18250292">{{cite journal |author=Thurman DJ, Stevens JA, Rao JK |title=Practice parameter: Assessing patients in a neurology practice for risk of falls (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology |journal=Neurology |volume=70 |issue=6 |pages=473–9 |year=2008 |pmid=18250292 |doi=10.1212/01.wnl.0000299085.18976.20 |issn=}}</ref> Examples of such tests are Gait velocity and the Timed-Up-and-Go tests.<ref name="pmid18177792">{{cite journal |author=van Iersel MB, Munneke M, Esselink RA, Benraad CE, Olde Rikkert MG |title=Gait velocity and the Timed-Up-and-Go test were sensitive to changes in mobility in frail elderly patients |journal=J Clin Epidemiol |volume=61 |issue=2 |pages=186-91 |year=2008 |pmid=18177792 |doi=10.1016/j.jclinepi.2007.04.016 |url=http://linkinghub.elsevier.com/retrieve/pii/S0895-4356(07)00210-7 |issn=}}</ref> A Timed-Up-and-Go test of < 15 seconds suggests a low risk of falling.<ref>Nordin E, Lindelöf N, Rosendahl E, Jensen J, Lundin-Olsson L. Prognostic validity of the Timed Up-and-Go test, a modified Get-Up-and-Go test, staff's global judgement and fall history in evaluating fall risk in residential care facilities. Age Ageing. 2008 Jul;37(4):442-8. Epub 2008 May 30. {{doi|10.1093/ageing/afn101}} PMID 18515291</ref> In the Timed-Up-and-Go test "patients to stand up from a chair, walk a short distance, turn around, return, and sit down again."<ref>Mathias S, Nayak US, Isaacs B. Balance in elderly patients: the "get-up and go" test. Arch Phys Med Rehabil. 1986 Jun;67(6):387-9. PMID 3487300</ref>
The presence of various medical conditions and the results of functional tests can assess the risk of falling.<ref name="pmid18250292">{{cite journal |author=Thurman DJ, Stevens JA, Rao JK |title=Practice parameter: Assessing patients in a neurology practice for risk of falls (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology |journal=Neurology |volume=70 |issue=6 |pages=473–9 |year=2008 |pmid=18250292 |doi=10.1212/01.wnl.0000299085.18976.20 |issn=}}</ref> Examples of such tests are Gait velocity and the Timed-Up-and-Go tests.<ref name="pmid18177792">{{cite journal |author=van Iersel MB, Munneke M, Esselink RA, Benraad CE, Olde Rikkert MG |title=Gait velocity and the Timed-Up-and-Go test were sensitive to changes in mobility in frail elderly patients |journal=J Clin Epidemiol |volume=61 |issue=2 |pages=186-91 |year=2008 |pmid=18177792 |doi=10.1016/j.jclinepi.2007.04.016 |url=http://linkinghub.elsevier.com/retrieve/pii/S0895-4356(07)00210-7 |issn=}}</ref> A Timed-Up-and-Go test of < 15 seconds suggests a low risk of falling.<ref>Nordin E, Lindelöf N, Rosendahl E, Jensen J, Lundin-Olsson L. Prognostic validity of the Timed Up-and-Go test, a modified Get-Up-and-Go test, staff's global judgement and fall history in evaluating fall risk in residential care facilities. Age Ageing. 2008 Jul;37(4):442-8. Epub 2008 May 30. {{doi|10.1093/ageing/afn101}} PMID 18515291</ref> In the Timed-Up-and-Go test "patients to stand up from a chair, walk a short distance, turn around, return, and sit down again."<ref>Mathias S, Nayak US, Isaacs B. Balance in elderly patients: the "get-up and go" test. Arch Phys Med Rehabil. 1986 Jun;67(6):387-9. PMID 3487300</ref>


====Causes====
===Causes===
Buckling, or sudden giving way, of the knees is associated with [[osteoarthritis]] of the knees and [[quadriceps]] muscle weakness.<ref name="pmid17938391">{{cite journal |author=Felson DT, Niu J, McClennan C, ''et al'' |title=Knee buckling: prevalence, risk factors, and associated limitations in function |journal=Ann. Intern. Med. |volume=147 |issue=8 |pages=534–40 |year=2007 |pmid=17938391 |doi=|url=http://www.annals.org/cgi/content/full/147/8/534}}</ref>
Buckling, or sudden giving way, of the knees is associated with [[osteoarthritis]] of the knees and [[quadriceps]] muscle weakness.<ref name="pmid17938391">{{cite journal |author=Felson DT, Niu J, McClennan C, ''et al'' |title=Knee buckling: prevalence, risk factors, and associated limitations in function |journal=Ann. Intern. Med. |volume=147 |issue=8 |pages=534–40 |year=2007 |pmid=17938391 |doi=|url=http://www.annals.org/cgi/content/full/147/8/534}}</ref>


Medications, especially psychotropic<ref name="pmid9920227">{{cite journal |author=Leipzig RM, Cumming RG, Tinetti ME |title=Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs |journal=Journal of the American Geriatrics Society |volume=47 |issue=1 |pages=30–9 |year=1999 |pmid=9920227 |doi=}}</ref> and cardiac<ref name="pmid9920228">{{cite journal |author=Leipzig RM, Cumming RG, Tinetti ME |title=Drugs and falls in older people: a systematic review and meta-analysis: II. Cardiac and analgesic drugs |journal=Journal of the American Geriatrics Society |volume=47 |issue=1 |pages=40–50 |year=1999 |pmid=9920228 |doi=}}</ref> are associated with increased risk of falling.
Medications, especially psychotropic<ref name="pmid9920227">{{cite journal |author=Leipzig RM, Cumming RG, Tinetti ME |title=Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs |journal=Journal of the American Geriatrics Society |volume=47 |issue=1 |pages=30–9 |year=1999 |pmid=9920227 |doi=}}</ref> and cardiac<ref name="pmid9920228">{{cite journal |author=Leipzig RM, Cumming RG, Tinetti ME |title=Drugs and falls in older people: a systematic review and meta-analysis: II. Cardiac and analgesic drugs |journal=Journal of the American Geriatrics Society |volume=47 |issue=1 |pages=40–50 |year=1999 |pmid=9920228 |doi=}}</ref> are associated with increased risk of falling.


====Prevention====
===Prevention===
;Individual interventions
====Individual interventions====
One [[randomized controlled trial]] reported that [[tai chi]], one hour per week for 16 weeks, can prevent falls in patients aged 60 or more.<ref name="pmid17661956">{{cite journal |author=Voukelatos A, Cumming RG, Lord SR, Rissel C |title=A randomized, controlled trial of tai chi for the prevention of falls: the Central Sydney tai chi trial |journal=Journal of the American Geriatrics Society |volume=55 |issue=8 |pages=1185–91 |year=2007 |pmid=17661956 |doi=10.1111/j.1532-5415.2007.01244.x}}</ref>
One [[randomized controlled trial]] reported that [[tai chi]], one hour per week for 16 weeks, can prevent falls in patients aged 60 or more.<ref name="pmid17661956">{{cite journal |author=Voukelatos A, Cumming RG, Lord SR, Rissel C |title=A randomized, controlled trial of tai chi for the prevention of falls: the Central Sydney tai chi trial |journal=Journal of the American Geriatrics Society |volume=55 |issue=8 |pages=1185–91 |year=2007 |pmid=17661956 |doi=10.1111/j.1532-5415.2007.01244.x}}</ref>


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Withdrawing psychotropics mediations may prevent falls.<ref name="pmid10404930">{{cite journal |author=Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM |title=Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized, controlled trial |journal=J Am Geriatr Soc |volume=47 |issue=7 |pages=850–3 |year=1999 |pmid=10404930 |doi=}}</ref><ref name="pmid18056731">{{cite journal |author=Campbell AJ, Robertson MC |title=Rethinking individual and community fall prevention strategies: a meta-regression comparing single and multifactorial interventions |journal=Age Ageing |volume=36 |issue=6 |pages=656–62 |year=2007 |pmid=18056731 |doi=10.1093/ageing/afm122}}</ref>
Withdrawing psychotropics mediations may prevent falls.<ref name="pmid10404930">{{cite journal |author=Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM |title=Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized, controlled trial |journal=J Am Geriatr Soc |volume=47 |issue=7 |pages=850–3 |year=1999 |pmid=10404930 |doi=}}</ref><ref name="pmid18056731">{{cite journal |author=Campbell AJ, Robertson MC |title=Rethinking individual and community fall prevention strategies: a meta-regression comparing single and multifactorial interventions |journal=Age Ageing |volume=36 |issue=6 |pages=656–62 |year=2007 |pmid=18056731 |doi=10.1093/ageing/afm122}}</ref>


;Multifactorial interventions
====Multifactorial interventions====
A [[meta-analysis]] by the [[Cochrane Collaboration]] found benefit among cummunity-dwelling persons from multidisciplinary, multifactorial, health, or environmental risk-factor screening or intervention programs.<ref name="pmid14583918">{{cite journal |author=Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH |title=Interventions for preventing falls in elderly people |journal=Cochrane database of systematic reviews (Online) |volume= |issue=4 |pages=CD000340 |year=2003 |pmid=14583918 |doi=10.1002/14651858.CD000340}} [[http://www.acpjc.org/Content/141/1/issue/ACPJC-2004-141-1-017.htm ACP Journal Club]]</ref> A more recent randomized controlled trial confirms this.<ref>Tinetti M et al. (2008) [http://content.nejm.org/cgi/content/full/359/3/252 Effect of Dissemination of Evidence in Reducing Injuries from Falls]. New England Journal of Medicine</ref><ref name="pmid15817016">{{cite journal |author=Baker DI, King MB, Fortinsky RH, ''et al'' |title=Dissemination of an evidence-based multicomponent fall risk-assessment and -management strategy throughout a geographic area |journal=J Am Geriatr Soc |volume=53 |issue=4 |pages=675–80 |year=2005 |month=April |pmid=15817016 |doi=10.1111/j.1532-5415.2005.53218.x |url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0002-8614&date=2005&volume=53&issue=4&spage=675 |issn=}}</ref>
A [[meta-analysis]] by the [[Cochrane Collaboration]] found benefit among cummunity-dwelling persons from multidisciplinary, multifactorial, health, or environmental risk-factor screening or intervention programs.<ref name="pmid14583918">{{cite journal |author=Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH |title=Interventions for preventing falls in elderly people |journal=Cochrane database of systematic reviews (Online) |volume= |issue=4 |pages=CD000340 |year=2003 |pmid=14583918 |doi=10.1002/14651858.CD000340}} [[http://www.acpjc.org/Content/141/1/issue/ACPJC-2004-141-1-017.htm ACP Journal Club]]</ref> A more recent randomized controlled trial confirms this.<ref>Tinetti M et al. (2008) [http://content.nejm.org/cgi/content/full/359/3/252 Effect of Dissemination of Evidence in Reducing Injuries from Falls]. New England Journal of Medicine</ref><ref name="pmid15817016">{{cite journal |author=Baker DI, King MB, Fortinsky RH, ''et al'' |title=Dissemination of an evidence-based multicomponent fall risk-assessment and -management strategy throughout a geographic area |journal=J Am Geriatr Soc |volume=53 |issue=4 |pages=675–80 |year=2005 |month=April |pmid=15817016 |doi=10.1111/j.1532-5415.2005.53218.x |url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0002-8614&date=2005&volume=53&issue=4&spage=675 |issn=}}</ref>


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An accidental fall is defined as a fall "due to slipping or tripping which results in injury".[1]

Falls in the elderly

At least a third of persons aged 65 years or more fall each year, with 10% leading to injury.[2]

Assessing risk

The presence of various medical conditions and the results of functional tests can assess the risk of falling.[3] Examples of such tests are Gait velocity and the Timed-Up-and-Go tests.[4] A Timed-Up-and-Go test of < 15 seconds suggests a low risk of falling.[5] In the Timed-Up-and-Go test "patients to stand up from a chair, walk a short distance, turn around, return, and sit down again."[6]

Causes

Buckling, or sudden giving way, of the knees is associated with osteoarthritis of the knees and quadriceps muscle weakness.[7]

Medications, especially psychotropic[8] and cardiac[9] are associated with increased risk of falling.

Prevention

Individual interventions

One randomized controlled trial reported that tai chi, one hour per week for 16 weeks, can prevent falls in patients aged 60 or more.[10]

A meta-analysis by the Cochrane Collaboration found benefit among cummunity-dwelling persons from:[11]

  • Individually targeted exercise or physical therapy consisting of strength training, balance, and walking.
  • Home safety interventions.

According to a subsequent meta-analysis by the Cochrane Collaboration, the role of modifying the home environment for the reduction of injuries has not been established.[12]

Withdrawing psychotropics mediations may prevent falls.[13][14]

Multifactorial interventions

A meta-analysis by the Cochrane Collaboration found benefit among cummunity-dwelling persons from multidisciplinary, multifactorial, health, or environmental risk-factor screening or intervention programs.[11] A more recent randomized controlled trial confirms this.[15][16]

References

  1. ↑ National Library of Medicine. Accidental Falls. Retrieved on 2007-10-17.
  2. ↑ Tinetti ME (2003). "Clinical practice. Preventing falls in elderly persons". N. Engl. J. Med. 348 (1): 42–9. DOI:10.1056/NEJMcp020719. PMID 12510042. Research Blogging.
  3. ↑ Thurman DJ, Stevens JA, Rao JK (2008). "Practice parameter: Assessing patients in a neurology practice for risk of falls (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology". Neurology 70 (6): 473–9. DOI:10.1212/01.wnl.0000299085.18976.20. PMID 18250292. Research Blogging.
  4. ↑ van Iersel MB, Munneke M, Esselink RA, Benraad CE, Olde Rikkert MG (2008). "Gait velocity and the Timed-Up-and-Go test were sensitive to changes in mobility in frail elderly patients". J Clin Epidemiol 61 (2): 186-91. DOI:10.1016/j.jclinepi.2007.04.016. PMID 18177792. Research Blogging.
  5. ↑ Nordin E, Lindelöf N, Rosendahl E, Jensen J, Lundin-Olsson L. Prognostic validity of the Timed Up-and-Go test, a modified Get-Up-and-Go test, staff's global judgement and fall history in evaluating fall risk in residential care facilities. Age Ageing. 2008 Jul;37(4):442-8. Epub 2008 May 30. DOI:10.1093/ageing/afn101 PMID 18515291
  6. ↑ Mathias S, Nayak US, Isaacs B. Balance in elderly patients: the "get-up and go" test. Arch Phys Med Rehabil. 1986 Jun;67(6):387-9. PMID 3487300
  7. ↑ Felson DT, Niu J, McClennan C, et al (2007). "Knee buckling: prevalence, risk factors, and associated limitations in function". Ann. Intern. Med. 147 (8): 534–40. PMID 17938391. [e]
  8. ↑ Leipzig RM, Cumming RG, Tinetti ME (1999). "Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs". Journal of the American Geriatrics Society 47 (1): 30–9. PMID 9920227. [e]
  9. ↑ Leipzig RM, Cumming RG, Tinetti ME (1999). "Drugs and falls in older people: a systematic review and meta-analysis: II. Cardiac and analgesic drugs". Journal of the American Geriatrics Society 47 (1): 40–50. PMID 9920228. [e]
  10. ↑ Voukelatos A, Cumming RG, Lord SR, Rissel C (2007). "A randomized, controlled trial of tai chi for the prevention of falls: the Central Sydney tai chi trial". Journal of the American Geriatrics Society 55 (8): 1185–91. DOI:10.1111/j.1532-5415.2007.01244.x. PMID 17661956. Research Blogging.
  11. ↑ 11.0 11.1 Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH (2003). "Interventions for preventing falls in elderly people". Cochrane database of systematic reviews (Online) (4): CD000340. DOI:10.1002/14651858.CD000340. PMID 14583918. Research Blogging. [ACP Journal Club]
  12. ↑ Lyons RA, John A, Brophy S, et al (2006). "Modification of the home environment for the reduction of injuries". Cochrane database of systematic reviews (Online) (4): CD003600. DOI:10.1002/14651858.CD003600.pub2. PMID 17054179. Research Blogging.
  13. ↑ Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM (1999). "Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized, controlled trial". J Am Geriatr Soc 47 (7): 850–3. PMID 10404930. [e]
  14. ↑ Campbell AJ, Robertson MC (2007). "Rethinking individual and community fall prevention strategies: a meta-regression comparing single and multifactorial interventions". Age Ageing 36 (6): 656–62. DOI:10.1093/ageing/afm122. PMID 18056731. Research Blogging.
  15. ↑ Tinetti M et al. (2008) Effect of Dissemination of Evidence in Reducing Injuries from Falls. New England Journal of Medicine
  16. ↑ Baker DI, King MB, Fortinsky RH, et al (April 2005). "Dissemination of an evidence-based multicomponent fall risk-assessment and -management strategy throughout a geographic area". J Am Geriatr Soc 53 (4): 675–80. DOI:10.1111/j.1532-5415.2005.53218.x. PMID 15817016. Research Blogging.

External links

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