Today we discussed the common problem of falls in the elderly. A few points:
May broadly approach causes for falls as "intrinsic" or "internal" vs "extrinsic" problem:
1) Exernal- overwhelming external hazards. Applies to anyone- surface (e.g. ice), tripping over surfaces, stairs, inadequate lighting, etc. Of course, the elderly may be less able to compensate for external hazards.
2) Internal- May be thought of like a computer (analogy courtesy of Dr. Ed Etchells)
Subdivided into: inputs, processing, and outputs, and power for the system
Inputs: vision, proprioception, vestibular apparatus
Therefore, problems with acuity, peripheral neuropathy, dorsal column pathology, inner ear pathology
Processing: cognition, basal ganglia, cerebellum
Therefore, primary CNS problems including dementia, Parkinson's, any cerebellar pathology
Output: Spinal cord, peripheral nerves, neuromuscular junction, muscle power.
Need adequate power to above system:
Cerebral blood flow, therefore arrhythmias, hypotension (inc postural), seizures.
Drugs: esp benzos (odds ratio of falling=30), but anything that causes postural hypotension (or hypotension in general), or any CNS depressant
Postural hypotension (need to check for it)
It may also be useful to divide falls into
1) isolated vs. chronic (look for acute medical issue in isolated)
2) with vs. without syncope (syncope involves a whole other differential)
Link:
Click here for a review paper on falls in the elderly, with references to evidence-based interventions to prevent falls and minimize morbidity from them
