Falls Prevention Day is today!

Yes, you heard it right. Today September 23, 2017 is Falls Prevention Day. 

Now as a typical Nigerian, you might ask ‘what is special about falling?’ A lot apparently, especially to the Neurologist who is often presented with the scenario of a patient with impaired consciousness and a history of fall. Which came first, the fall or the impaired consciousness?

No age group is immune from falling. However as people get older, falls become a significant source of concern. Even the fear of falls can lead to a major decline in physical activity. Falls can be costly to manage and also be crippling to the individual, particularly so for ensuing fractures in the proximal femur, which may herald a downward spiral in the person’s quality of life and eventual mortality.

Falls can cause neurological disease while neurological diseases frequently cause falls. Whichever way, it is much better to prevent falls. The following are risk factors for falls (1,2):-

• Age >80.
• Female gender (this may be a true gender difference or a result of women being more likely to seek medical care and advice after a fall).
• Low weight.
• A history of fall in the previous year.
• Dependency in activities of daily living.
• Orthostatic hypotension - one study reported a 69% increased risk of having an injurious fall during the first 45 days following antihypertensive treatment.
• Medication - the leading culprits are psychotropics (especially benzodiazepines, antidepressants and antipsychotics), blood pressure-lowering drugs and anticonvulsants.
• Polypharmacy - a 14% increase in fall risk in one study with the addition of each medication beyond a four-medication regime, irrespective of the group of drugs studied.
• Alcohol misuse.
• Diabetes mellitus.
• Confusion and cognitive impairment.
• Disturbed vision.
• Disturbed balance or co-ordination.
• Gait disorders.
• Urinary incontinence.
• Inappropriate footwear.
• Environmental factors including home hazards.
• Muscle weakness.
• Depression.

Specific neurological diseases causing falls include seizures (epileptic and non epileptic), syncope (e.g vasovagal syncope), stroke/ transient ischaemic attack, Parkinson’s disease, spinal disorders (e.g cervical spondylosis), polyneuropathy, subcortical arteriosclerotic encephalopathy, vertiginous disorders, pain syndromes, multiple sclerosis, CNS tumours and motor neurone diseases (3). Common examples of neurological disease arising from falls include subdural and extradural haemorrhages and other traumatic encephalopathies.

Prevention of new or repeat falls

A fall should be seen as a symptom and never as a diagnosis. Anyone who has been admitted to hospital as a result of a fall or who has been identified as being at-risk should be assessed properly and identified disorders managed appropriately. This addresses primary and secondary prevention of falls clinically. There are other home and environmentally based approaches.

References:

1.        Falls: assessment and prevention of falls in older people; NICE Clinical Guideline (June 2013)

2.        Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing. 2006 Sep 35 Suppl 2:ii37-ii41.

3.       Stolze H, Klebe S, Zechlin C, Baecker C, Friege L, Deuschl G. Falls in frequent neurological diseases – prevalence, risk factors and aetiology. J Neurol. 2004 Jan; 251(1):79-84.