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"Every block of stone has a statue inside it… It is the task of the sculptor to discover it."
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—Michelangelo Buonarroti, Italian sculptor, painter, architect, poet (1475–1564)
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LEARNING OUTCOMES
By the end of this chapter, readers will be able to:
Define falls and near falls.
Discuss the epidemiology of falls.
Identify the clinical implications and consequences of falls for older adults.
Identify older adults who are at greatest risk of falling.
Distinguish between modifiable and nonmodifiable, intrinsic and extrinsic, age-related/biological, lifestyle/behavior, environmental, and community fall risk factors.
Describe the components of an assessment for falls and fall risk in the older adult.
Describe evidence-based, best practice falls and fall risk assessment and intervention strategies.
Describe intervention strategies aimed at fall prevention.
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Clinical Vignette
Mr. Aban Najjar is an 80-year-old man who lives alone independently in a large, old house with several steps to the front entrance. Mr. Najjar has two supportive daughters and seven adult grandchildren who live nearby. Mr. Najjar is a retired lawyer. He has two cats and has an active social life with many friends. He goes out every day to meet up with friends or run errands.
Mr. Najjar has recently been experiencing symptoms of dizziness, particularly when getting out of bed or out of a chair, and reports feeling unsteady on his feet. His daughters report that Mr. Najjar is exhibiting some anxiety about going out of the house because of the unsteadiness. Past medical history includes hypertension, type 2 diabetes, osteoarthritis, bilateral total hip replacement, L3–5 spinal stenosis and leg numbness/paresthesia, cataracts, benign prostatic hypertrophy, with 3–4 times per night nocturia and occasional incontinence. Medications include metformin 500 mg daily, Flomax 0.8 mg at bedtime, gabapentin two 300-mg tablets three times daily, Advil 500 mg one to two four times daily as needed, Tribenzor 25 mg daily.
Is Mr. Najjar at risk for falls? Why?
What risk factors for falls does Mr. Najjar have? Can anything be done about the risk factors?
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Falls in older adults are a significant health concern, and an extensively researched topic. Conducting a literature search of "older adult" and "falls" as key words, restricted to the English language and to the past 10 years yields more than 900,000 hits in just one database! This chapter focuses on some of the essential concepts and elements related to falls in older adults for the occupational and physical therapist. However, as an entire book could be devoted to the topic of falls in older adults, the interested reader should refer to the reference list and the Web resources in the ancillaries for additional information.
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Definition of Fall and Near-Fall
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The World Health Organization's (2007) Global Report on Falls Prevention in Older Age notes that the rapid growth in the aging population makes falls prevention an important objective worldwide. A fall ...