Managing Recurrent Falls in the Elderly
Multifactorial interventions including exercise, medication review, and home safety assessment are the most effective approach for managing recurrent falls in the elderly. 1
Assessment of Fall Risk Factors
A comprehensive fall risk assessment should include:
- Orthostatic blood pressure measurements to detect postural hypotension 1
- Medication review with particular attention to psychotropics, cardiovascular medications, and analgesics 1
- Gait and balance assessment using the "Get Up and Go" test 1
- Neurological examination focusing on neuropathies and proximal motor strength 1
- Cognitive assessment using Mini-Mental State Examination 1
- Laboratory tests including complete blood count, electrolytes, renal function, glucose, thyroid function, vitamin B12, and ferritin levels 1
- Home environment evaluation for hazards 2
Evidence-Based Intervention Strategy
1. Exercise Program (Highest Priority)
- Implement structured exercise focusing on:
- Balance and functional training
- Strength/resistance training
- Flexibility exercises
- Gait training
- Recommended frequency: 3 sessions per week for 12 months
- Duration: 50-60 minutes daily 1
- Long-term exercise and balance training should be offered to those with recurrent falls 2
- Tai Chi is a promising balance exercise but requires further evaluation 2
2. Medication Review and Modification
- Review and reduce medications, especially:
- Psychotropic medications (neuroleptics, benzodiazepines, antidepressants)
- Vasodilators
- Diuretics
- Antipsychotics
- Sedatives/hypnotics 1
- Special attention should be given to older persons taking four or more medications 2
3. Home Safety Assessment and Modification
- Remove tripping hazards
- Install handrails and grab bars
- Improve lighting
- Ensure even floor surfaces 1
- A facilitated environmental home assessment should be considered for high-risk patients 2
4. Management of Medical Conditions
- Address cardiovascular disorders including carotid sinus hypersensitivity
- Correct visual problems
- Treat vitamin deficiencies (B12, vitamin D) 3
- Manage osteoporosis to prevent fractures 1
Special Considerations
For High-Risk Patients
- Consider external hip protectors to prevent fractures 1
- Expedite outpatient follow-up after falls 1
- Refer frail patients to specialist care of the elderly team 1
Common Pitfalls to Avoid
- Failure to obtain brain imaging in elderly patients with new-onset falls 1
- Missing orthostatic hypotension by not checking postural vital signs 1
- Overlooking medication side effects as contributors to falls 1
- Relying on advice alone about fall risk factor modification without implementing recommended changes 2
Follow-up and Monitoring
- Reassess fall risk at all transition points and whenever there is a change in health status 1
- Reassess frailty status every 1-2 years for those who are frail or pre-frail 1
- Monitor functional status and quality of life for improvement 1
Effectiveness of Interventions
- Multifactorial interventions may reduce the rate of falls by approximately 23% compared to usual care 4
- Multiple component interventions probably reduce the rate of falls by about 26% 4
- Exercise is the most consistently beneficial component across studies 1
The evidence strongly supports that a systematic approach addressing multiple risk factors is more effective than single interventions for preventing recurrent falls in the elderly 1, 4.