Fall Risk and Pharmacotherapy
Maintaining postural stability in the supine position is a complex task and therefore vulnerable to disturbance by a variety of factors that may cause loss of stability and result in falls. In the elderly, as opposed to younger patients, a fall from stand
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Introduction Maintaining postural stability in the supine position is a complex task and therefore vulnerable to disturbance by a variety of factors that may cause loss of stability and result in falls. In the elderly, as opposed to younger patients, a fall from standing or a fall while walking at low speed may end up in clinically significant incidents, namely, fractures. Typical falls in the elderly have to be distinguished from syncope, which describes a short-time loss of consciousness of sudden onset. In every fall incident, a syncope has to be ruled out as its management requires different diagnostic and therapeutic algorithms aiming at underlying cardiac diseases. Syncopes may also be provoked by drug therapy due to bradycardia, torsades, or orthostatic hypotension. In the following, we focus on typical falls in the elderly. It is estimated that one third of all ambulatory elderly aged 65+ years will experience a fall event at least once a year. Among those aged 80+ years, this portion is estimated to rise to about 50% (Tinetti et al. 1988). This also leads to an increased risk of mortality and aggravated morbidity in the elderly (Stel et al. 2004), which is even more pronounced in elderly living in
H. Burkhardt (*) IVth Department of Medicine, Geriatrics, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany e-mail: [email protected]
nursing homes or comparable institutions (e.g., hospitals) (Kron et al. 2003). In the elderly, the fracture rate attributed to falls is about 5%. Most common fractures are hip and radius fractures. Mortality rates of fracture incidents are rising with advancing age. In this context, hip fractures are most significant. The 12-month mortality rate after hip fracture increases to 24% in the elderly, as revealed by a U.S. government study (U.S. Congress, Office of Technology Assessment 1994). Besides this, more than 40% of all elderly patients suffering a hip fracture were not able to return home and had to be discharged to nursing homes or similar facilities. A major reason for this increasing threat in the elderly accompanying fall incidents is the increasing prevalence of osteoporosis in this population. In addition, in the elderly changes of physiological responses may lead to less-effective compensations in case of falls (e.g., reduced protective reflexes). In this context, the most significant changes in the elderly are – Reduced muscle mass (sarcopenia) – Reduced visual acuity – Changes in the nervous system – Frequent orthostatic hypotension. Prevalence of orthostatic hypotension may exceed 30% in elderly aged 75+ years (Gupta and Lipsitz 2007). Some of these arguments match with the criteria that define frailty (see chapter “Pharmacotherapy and the Frailty Syndrome”), thus pointing to the high inherent risk of falls in frail elderly.
M. Wehling (ed.), Drug Therapy for the Elderly, DOI 10.1007/978-3-7091-0912-0_19, # Springer-Verlag Wien 2013
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training decompensation = fall postural stability
Fig. 1 Postural stability ac
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