Pathogenesis and treatment of falls in elderly

Abstract

Falls in the elderly are a public health problem. Consequences of falls are increased risk of hospitalization, which results in an increase in health care costs. It is estimated that 33% of individuals older than 65 years undergoes falls. Causes of falls can be distinguished in intrinsic and extrinsic predisposing conditions. The intrinsic causes can be divided into age-related physiological changes and pathological predisposing conditions. The age-related physiological changes are sight disorders, hearing disorders, alterations in the Central Nervous System, balance deficits, musculoskeletal alterations. The pathological conditions can be Neurological, Cardiovascular, Endocrine, Psychiatric, Iatrogenic. Extrinsic causes of falling are environmental factors such as obstacles, inadequate footwear. The treatment of falls must be multidimensional and multidisciplinary. The best instrument in evaluating elderly at risk is Comprehensive Geriatric Assessment (CGA). CGA allows better management resulting in reduced costs. The treatment should be primarily preventive acting on extrinsic causes; then treatment of chronic and acute diseases. Rehabilitation is fundamental, in order to improve residual capacity, motor skills, postural control, recovery of strength. There are two main types of exercises: aerobic and muscular strength training. Education of patient is a key-point, in particular through the Back School. In conclusion falls in the elderly are presented as a "geriatric syndrome"; through a multidimensional assessment, an integrated treatment and a rehabilitation program is possible to improve quality of life in elderly.

Keywords: comprehensive geriatric assessment; elderly; falls; multidimensional assessment.

Figure 1

Prevalence of falls by Sex and Age Groups, Canada 2002–03 (adapted from Report on seniors fall in Canada. Public Health Agency of Canada, 2005).

Figure 2

Risk factor in falls: metanalysis in 16 studies (adapted from American Geriatrics Society, British Geriatrics Society and American Academy of Orthopaedic Surgeons: Guidelines for the prevention of falls in older persons. Journal of American Geriatric Society. 2001;49(5):664–72).

Figure 3

Geriatric care management: quality of medical care (adapted from Counsell SR, et al. Geriatric care management for low-income seniors: a randomized controlled trial. Journal of American Medical Association. 2007;298:2623–33).