Falls

What are falls?

A fall is a descent under the force of gravity and can be a major cause of personal injury. The consequences of a fall may result in a mild soft tissue injury but can also be fatal.

Physical injury

Fracture: In particular the neck of the femur (Hyndman et al. 2002). The incidence of fracture as a result of a fall is between 0.6% and 8.5% (Teasell et al. 2002). In cerebrovascular accident (CVA) the most common fracture is of the hip (45–59%) on the affected side (Dennis et al. 2002).

Soft tissue injuries: Include bruises and open wounds (risk of infection) (Hyndman et al. 2002).

Psychosocial impact

Fear of further falls: Lack of confidence often leads to activity avoidance, greater disability, lack of independence and social isolation (Hyndman et al. 2002; Mackintosh et al. 2005). Activity avoidance also has many secondary consequences which perpetuate the chance of a fall, e.g. reduced exercise tolerance, impaired balance responses, altered body schema, depressed mood and loss of bone mineral density (osteoporosis).

The aim of The National Service Framework for older people (Standard 6 – Falls) (NSF 2001) is to reduce the number of falls which result in serious injury and ensure effective treatment and rehabilitation for those who have fallen. In order to achieve this, preventive intervention and curative rehabilitation are viewed as equally important and therefore an assessment of the relevant risk factors is essential.

Risk factors for falling

Being aware of the potential risk factors for falls allows the therapist to predict and hopefully prevent a fall. The aetiology of falls is multifactorial with the risk of falling increased with the number of risk factors. There is substantial evidence related to falls in the older person which takes into account the neurological pathologies associated with this age group.

The main points will be drawn out here, however for a more comprehensive understanding of this area the reader is referred to the NSF (2001) and The National Institute for Clinical Excellence guidelines for the assessment and treatment of falls in the older person (NICE 2004). Fall-related risk factors for the elderly are generally classified into intrinsic and extrinsic.