Evaluation of falls in the elderly

Underlying causes and complications of falls are numerous, but the following associations warrant more immediate evaluation.[100]Brignole M. Diagnosis and treatment of syncope. Heart. 2007 Jan;93(1):130-6. http://www.ncbi.nlm.nih.gov/pubmed/17170354?tool=bestpractice.com [101]Corona G, Norello D, Parenti G, et al. Hyponatremia, falls and bone fractures: a systematic review and meta-analysis. Clin Endocrinol (Oxf). 2018 Oct;89(4):505-13. https://www.doi.org/10.1111/cen.13790 http://www.ncbi.nlm.nih.gov/pubmed/29920727?tool=bestpractice.com [102]Ohm C, Mina A, Howells G, et al. Effects of antiplatelet agents on outcomes for elderly patients with traumatic intracranial hemorrhage. J Trauma. 2005 Mar;58(3):518-22. http://www.ncbi.nlm.nih.gov/pubmed/15761345?tool=bestpractice.com [103]Feldstein A, Elmer PJ, Orwoll E, et al. Bone mineral density measurement and treatment for osteoporosis in older individuals with fractures: a gap in evidence-based practice guideline implementation. Arch Intern Med. 2003 Oct 13;163(18):2165-72. http://archinte.jamanetwork.com/article.aspx?articleid=216119 http://www.ncbi.nlm.nih.gov/pubmed/14557214?tool=bestpractice.com

• History of sudden change in alertness or level of consciousness: possible causes include cerebrovascular (transient ischemic attack, stroke, seizure), cardiovascular (hypotension, bradycardia or tachycardia), electrolyte abnormalities (such as hyponatremia), medication adverse effects (especially newly prescribed), or infection.

• New head trauma: concurrent use of anticoagulation or antiplatelet therapy raises concern for a subdural hematoma.

• Pain suggesting a potential fracture: persistent pain, inability to bear weight, or any obvious anatomical abnormality should prompt a quick evaluation for fracture, along with appropriate orthopedic consultation. Consideration should be given to treating osteoporosis in patients with fractures associated with low-impact falls.