 |
|
CLINICIAN'S CORNER
Will My Patient Fall?
David A. Ganz, MD, MPH;
Yeran Bao, MD;
Paul G. Shekelle, MD, PhD;
Laurence Z. Rubenstein, MD, MPH
JAMA. 2007;297:77-86.
Context Effective multifactorial interventions reduce the frequent falling rate of older patients by 30% to 40%. However, clinical consensus suggests reserving these interventions for high-risk patients. Limiting fall prevention programs to high-risk patients implies that clinicians must recognize features that predict future falls.
Objective To identify the prognostic value of risk factors for future falls among older patients.
Data Sources and Study Selection Search of MEDLINE (1966-September 2004), CINAHL (1982-September 2004), and authors' own files to identify prospective cohort studies of risk factors for falls that performed a multivariate analysis of such factors.
Data Extraction Two reviewers independently determined inclusion of articles and assessed study quality. Disagreements were resolved by consensus. Included studies were those identifying the prognostic value of risk factors for future falls among community-dwelling persons 65 years and older. Clinically identifiable risk factors were identified across 6 domains: orthostatic hypotension, visual impairment, impairment of gait or balance, medication use, limitations in basic or instrumental activities of daily living, and cognitive impairment.
Data Synthesis Eighteen studies met inclusion criteria and provided a multivariate analysis including at least 1 of the risk factor domains. The estimated pretest probability of falling at least once in any given year for individuals 65 years and older was 27% (95% confidence interval, 19%-36%). Patients who have fallen in the past year are more likely to fall again [likelihood ratio range, 2.3-2.8]. The most consistent predictors of future falls are clinically detected abnormalities of gait or balance (likelihood ratio range, 1.7-2.4). Visual impairment, medication variables, decreased activities of daily living, and impaired cognition did not consistently predict falls across studies. Orthostatic hypotension did not predict falls after controlling for other factors.
Conclusions Screening for risk of falling during the clinical examination begins with determining if the patient has fallen in the past year. For patients who have not previously fallen, screening consists of an assessment of gait and balance. Patients who have fallen or who have a gait or balance problem are at higher risk of future falls.
Author Affiliations: Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, Calif (Drs Ganz, Shekelle, and Rubenstein); University of California, Los Angeles Multicampus Program in Geriatric Medicine and Gerontology (Drs Ganz, Bao, and Rubenstein); Robert Wood Johnson Clinical Scholars Program, Los Angeles (Dr Ganz); and RAND Health, Santa Monica, Calif (Dr Shekelle). Dr Bao is now at Palo Alto Veterans Affairs Medical Center, Palo Alto, Calif.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
It takes a village to prevent falls: reconceptualizing fall prevention and management for older adults
Ganz et al.
Inj. Prev. 2008;14:266-271.
ABSTRACT
| FULL TEXT
Prognostic validity of the Timed Up-and-Go test, a modified Get-Up-and-Go test, staff's global judgement and fall history in evaluating fall risk in residential care facilities
Nordin et al.
Age Ageing 2008;37:442-448.
ABSTRACT
| FULL TEXT
Screening for Osteoporosis in Men: A Systematic Review for an American College of Physicians Guideline
Liu et al.
ANN INTERN MED 2008;148:685-701.
ABSTRACT
| FULL TEXT
Invited Commentary
Studenski
ptjournal 2008;88:460-461.
FULL TEXT
Shifting the focus in fracture prevention from osteoporosis to falls
Jarvinen et al.
BMJ 2008;336:124-126.
FULL TEXT
Orthostatic hypotension: framework of the syndrome
Naschitz and Rosner
Postgrad. Med. J. 2007;83:568-574.
ABSTRACT
| FULL TEXT
Geriatric Conditions and Disability: The Health and Retirement Study
Cigolle et al.
ANN INTERN MED 2007;147:156-164.
ABSTRACT
| FULL TEXT
Response to Kok, Nolen, and Heeren's Letter to the Editor
Whyte and Mulsant
AJGP 2007;15:726-726.
FULL TEXT
Why old people fall (and how to stop them)
Voermans et al.
PN 2007;7:158-171.
FULL TEXT
|
