Introduction to geriatrics

Falls in older adults

• Evaluation:
  • History: Assess fall vs syncope (LOC), previous falls, prodrome, “long lie” duration.
  • Vitals: Orthostatic vitals (drop $\ge$ 20 mmHg SBP or $\ge$ 10 mmHg DBP).
  • Physical Exam: CV (murmurs/arrhythmias), neuro (focal deficits, peripheral neuropathy via monofilament), MSK (joints, feet), visual acuity c
  • Functional Testing: Timed Up and Go (TUG) test ($\ge$ 12 seconds indicates high fall risk).
• Workup (Targeted):
  • Initial Labs: BMP (electrolytes, BUN/Cr), glucose, CBC, UA (r/o delirium/UTI).
  • ECG: First-line if syncope, palpitations, or known cardiac disease suspected; telemetry/TTE if indicated.
  • Non-Contrast Head CT: Indicated for head strike with LOC, new focal neurologic deficit, altered mental status, or pt on anticoagulation/antiplatelets (r/o SDH).
  • X-rays: Indicated for focal bone tenderness or inability to bear weight (r/o fracture).
• Outpatient prevention:
  • Exercise/Physical Therapy: Single most effective intervention in community-dwelling older adults (gait, balance, strength training, Tai Chi).
  • Screening: musculoskeletal (eg, “get up & go” test*), vision, hearing, bone density, orthostasis c
  • Medication & home safety review
  • Correction of vitamin D deficiency (in select patients)
  • Supervised exercise program
• Inpatient prevention
  • Assess fall risk & customize strategies to patient’s specific risk factors c
  • Optimize environment (eg, minimize furniture, lower the bed, place in direct view of nurses if high risk)
  • Perform frequent checks on high-risk patients
  • Avoid restraints & overreliance on fall alert systems