Table 2 Recommended Components of a Clinical Assessment and Management of Older Persons with Previous Falls (Adapted from Tinetti [27])
From: Occupational health for an ageing workforce: do we need a geriatric perspective?
Risk Factor | Management |
|---|---|
Circumstances of previous falls | Changes in environment to reduce the likelihood of recurrent falls. |
Medication use - High risk medications (e.g. benzodiazepines, sedatives, neuroleptics, anti-depressants, anti-convulsants, Class 1A anti-arrhythmics) - Polypharmacy (4 or more medications) | Review and reduction of medications |
Vision - Acuity <20/60 - Decreased depth perception - Decreased contrast sensitivity - Cataracts | - Ample lighting - Avoidance of multifocal glasses while walking - Referral to ophthalmologist |
Postural blood pressure (after 5 mins in a supine position, immediately after standing and 2 mins after standing) - >20 mmHg or (>20%) drop in systolic pressure, with or without symptoms, either immediately or after 2 min of standing, is significant | Diagnosis and treatment of underlying cause, if possible. Review and reduction of medications; modification of salt restriction, adequate hydration, pressure stockings; fludrocortisone therapy if above strategies fail |
Balance and gait - Patient's report or observed unsteadiness. - Impairment on brief assessment (e.g. Get-Up-And-Go test) | Diagnosis and treatment of underlying cause, if possible. Review and reduction of medications; referral to physical therapist for assistive devices and gait, balance and strength training |
Targeted neurological examination - Impaired proprioception - Impaired cognition - Decreased muscle strength | Diagnosis and treatment of underlying cause, if possible; increase proprioceptive input (e.g. with assistive device or appropriate footwear that encases the foot and has a low heel and thin sole); review and reduction of medications; referral to physical therapist for assistive devices and gait, balance and strength training |
Targeted musculoskeletal examination - examination of legs - examination of feet | Diagnosis and treatment of underlying cause, if possible; referral to physical therapist for assistive devices and gait, balance and strength training; use appropriate footwear, referral to podiatrist |
Targeted cardiovascular examination - Syncope - Arrhythmia | Diagnosis and treatment of underlying cause, if possible; referral to cardiologist |