Falls and Fracture Prevention

Epidemiology & Impact - Geriatric Ground Zero

• Prevalence: 1 in 3 adults >65 years fall each year; rates ↑ with age & in long-term care.
• Common Injuries: Hip fractures (high morbidity/mortality), traumatic brain injuries (TBI), wrist & vertebral fractures.
• Consequences:
  • Significant cause of hospitalization & ↑ healthcare utilization.
  • Leads to disability, loss of independence, premature institutionalization.
  • Fear of Falling (FoF) cycle: ↓ activity → deconditioning → ↑ fall risk.
  • Major contributor to injury-related death in the elderly.

⭐ Falls are a leading cause of non-fatal injuries and hospital admissions for trauma in older adults.

Risk Factors - Stumble Suspects

• Illumination (poor)
• Hazards (environmental)
• Assistive devices (lack/improper use)
• Transfer techniques (unsafe)
• Education (lack of awareness)
• Footwear (inappropriate)
• Age-related changes
• Low blood pressure (postural hypotension)
• Locomotor problems (gait/balance)
• Incontinence (urgency leading to rush)
• Nutrition (malnutrition, vitamin D deficiency)
• General debility/frailty

⭐ Postural hypotension (a drop of ≥20 mmHg systolic or ≥10 mmHg diastolic BP within 3 mins of standing) is a common, often reversible, cause of falls in the elderly and frequently linked to medications like antihypertensives and diuretics. Polypharmacy significantly elevates this risk when ≥4-5 medications are used concurrently, especially sedatives and psychotropics.

Assessment & Screening - Tumble Detectives

• Comprehensive Geriatric Assessment (CGA): Holistic evaluation to identify risk factors.
• Fall History: Detailed account of fall circumstances.
  • 📌 SPLATT Mnemonic:
    • Symptoms at time of fall
    • Previous falls
    • Location of fall
    • Activity at time of fall
    • Time of day
    • Trauma post-fall
• Medication Review: Identify polypharmacy & high-risk drugs (e.g., sedatives, antihypertensives).
• Physical Examination:
  • Vision & hearing acuity.
  • Cardiovascular: Orthostatic hypotension (check BP lying & standing).
  • Neurological: Cognition, peripheral neuropathy, reflexes.
  • Musculoskeletal: Gait, balance (e.g., Romberg), muscle strength (e.g., chair stand test).
• Functional Assessment Tools:
  • Timed Up and Go (TUG) Test: >12-14 seconds indicates ↑ fall risk.
  • Berg Balance Scale (BBS).
  • Tinetti Performance Oriented Mobility Assessment (POMA).

⭐ The 'Timed Up and Go' (TUG) test is a simple, widely used tool to assess mobility and predict fall risk; a time >12-14 seconds indicates a high risk of falling and warrants further assessment.

Prevention & Management - Safety Shield Plan

Key interventions:

• Additional Fall Prevention:
  • Vision Correction: Regular eye exams, updated eyewear.
  • Footwear Advice: Proper fit, low heel, non-slip soles.

Core Intervention Domains Table:

Simplified Osteoporosis Management Post-Fall:

High‑Yield Points - ⚡ Biggest Takeaways

• Multifactorial risk assessment is crucial for preventing falls in older adults.
• The Timed Up and Go (TUG) test; >12 seconds indicates an increased fall risk.
• Vitamin D (800-1000 IU/day) and Calcium (1000-1200 mg/day) supplementation is vital for bone health.
• Bisphosphonates (e.g., Alendronate, Zoledronic acid) are first-line pharmacological therapy for osteoporosis.
• Regular exercise programs incorporating balance, strength, and gait training significantly reduce fall incidence.
• Conduct a thorough medication review to identify and minimize high-risk drugs (e.g., psychotropics, polypharmacy).
• Home environment assessment and modification can substantially reduce extrinsic fall hazards for elderly patients.