Resumo

Identifying the circumstances surrounding, and the symptoms associated with, a fall helps to determine the underlying cause, which in turn emphasises the importance of obtaining a detailed history of the fall. Identifying the cause will determine whether a more urgent medical evaluation is necessary to address life-threatening causes of falls and their consequences. This investigation will also help to identify the risk factor(s) most likely to be contributing to falls and allow the implementation of appropriate interventions to reduce the risk of future falls.

Falls are often multifactorial in origin. [1] The presence of the following factors is associated with greater probability of future falls, [2] [3] [4] and falls screening guidelines suggest identification of these characteristics in at-risk people can be useful in the implementation of falls prevention strategies: [5]

• Motor problems: gait and balance impairment, muscle weakness [2] [6] [7] [8] [9] [10]

• Sensory impairment: peripheral neuropathy, vestibular dysfunction, vision impairment [2] [6] [11] [12] [13]

• Cognitive or mood impairment: dementia, depression [7] [9]

• Orthostatic hypotension [2] [6]

• Polypharmacy or certain medicines [14]

• Impairment of activities of daily living [15] [16] [17]

• Environmental hazards such as loose rugs [2]

• Additional factors such as age or comorbid illnesses. [2]

Key components of many fall-prevention programmes include addressing the risk factors, advocating exercise (including strength and balance training), review of medication, vision assessment, and a home safety assessment, with modifications as deemed necessary. [18] The United States Preventive Services Task Force, for example, recommends exercise or physical therapy, plus vitamin D supplementation, for prevention of falls in community-dwelling adults ≥65 years of age who are at increased risk of falls. [19] [20]

Several other guidelines examine the implementation of such interventions to prevent falls:

• [US Preventive Services Task Force: primary care-relevant interventions to prevent falling in older adults]

• [AMDA: falls and fall risk]

• [CDC: preventing falls among older adults]

• [BC Injury Research and Prevention Unit: fall prevention guidelines]

• [ACSQHC: preventing falls and harm from falls in older people in residential aged care facilities]

• [ACSQHC: preventing falls and harm from falls in older people in the community]

• [Institute for Clinical Systems Improvement: prevention of falls (acute care)]

• [Effectiveness and implementation aspects of interventions for preventing falls in elderly people in long-term care facilities: a systematic review of RCTs]