Falls are an important cause of morbidity and mortality for the elderly living in the community. Identification of certain risk factors can help direct interventions to reduce the risk for a patient.
Patient population: adults age 75 years or older living in the community
|
Risk Factors for Falls |
Adjusted Odds Ratio (95% CI) |
|
use of sedatives |
28.3 (3.4 - 239.4) |
|
cognitive impairment |
5.0 (1.8 - 13.7) |
|
lower extremity disability |
3.8 (2.2 - 6.7) |
|
palmomental reflex |
3.0 (1.5 - 6.1) |
|
foot problems |
1.8 (1.0 - 3.1) |
|
balance and gait abnormalities, 0 to 2 |
1.0 |
|
balance and gait abnormalities, 3 to 5 |
1.4 (0.7 - 2.8) |
|
balance and gait abnormalities, 6 to 7 |
1.9 (1.0 - 3.7) |
where:
• Sedatives include benzodiazepines, phenothiazines and antidepressants
• Cognitive impairment was considered positive if the subject made at least 5 errors on a short, portable mental status questionnaire (J Am Geriatr Soc. 1975; 23: 433-441)
• Lower extremity disability includes any reported problem with strength, sensation or balance.
• Foot problems include moderate or severe bunions, ulcers or deformed nails.
• Palmomental reflex: forceful stroking of the palm causing homolateral chin muscle contraction, indicating diffuse brain damage
• Although 3 separate risk groups were identified based on the number of balance and gait abnormalities, I could not the number needed to be considered a risk factor. I used >= 3 in the associated spreadsheet.
|
Abnormalities of Balance and Gait |
Finding |
|
balance abnormality |
unsteady sitting down |
|
|
unable to stand on one leg unsupported |
|
|
unsteady turning |
|
|
unsteady after gentle push to sternum |
|
gait abnormality |
increased trunk sway |
|
|
unable to pick up walking pace |
|
|
increased path deviation |
number of risk factors =
= SUM(risk factors present as listed in risk factor table)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 6
|
Number of Risk Factors |
Percent Falling |
|
0 |
8% |
|
1 |
19% |
|
2 |
32% |
|
3 |
60% |
|
>= 4 |
78% |
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general
ICD-10: ,
