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Falls

This page give the background and potential complications of patients who present with a fall. Ideal revision for medical student OSCEs and PACES

Background to falls

  • Falls are one of the “Geriatric Giants”.
  • Falls are a frequently encountered presentation or referral both to the emergency department and also to GP/rapid access clinics, but are commonly – and at times mistakenly – diagnosed as a “mechanical fall”.
  • As with all aspects of geriatric care, falls should ideally receive a comprehensive assessment to ensure that any modifiable underlying risk factor has been identified and, if possible, corrected.

 

Epidemiology of falls

  • The rate and incidence of falls both increase with age, as multiple background co-morbidities combine to increase risk.
  • 30% of the over-65 year-old population will have at least one fall per year, rising to 50% in over-80s.
  • Estimated cost to the NHS of more than £2.3 billion per year in 2015
  • Greater emphasis should perhaps be placed on falls prevention, but as it is often only following a fall that a patient comes to the attention of health services, it justifies the comprehensive assessment into any patient who presents with a fall, as this may go some way to help prevent future incidents.

 

 

Complications following a fall

  • Fall complications are not only physical (bumps, bruises, broken bones) but also psychological.
  • Physical
    • Immediate
      • Fractured neck of femur (#NOF)
        • One of the most serious (but common) injuries experienced by patients who suffer a fall is a fractured neck of femur
        • A fractured NOF leads to a relative increase in mortality at 3 months post-injury of 5.75 in older women, and 7.95 in older men.
      • Other fractures (e.g. radius/humerus)
      • Soft tissue injury (and skin breaks)
    • Delayed
      • Immobility
      • VTE and PE
      • Pressure ulceration
      • Incontinence
        • A reduction in mobility following a fall (as a result of either physical or psychological disability) can also lead to issues with incontinence
        • This in turn can cause both physical and psychological complications.
      • Psychological
        • The incidence of a fear of falling doubles in patients who have suffered a previous fall.
        • That fear of falling itself also correlates with both an increased risk in future fall, but also a lower quality of life and higher mortality.
        • As such, the importance of not being dismissive of any patient who has fallen cannot be emphasised enough.

 

Now click here for how to do a thorough assessment in a patient with falls: history, examination, investigations and management 

…or click here to learn about delirium

 

References