Clinical meaning
Falls in older adults result from complex interactions between intrinsic factors (age-related physiological decline) and extrinsic factors (environmental hazards). Age-related changes include decreased proprioception (reduced joint position sense from mechanoreceptor degeneration), impaired vestibular function (otoconia degeneration reducing balance input), decreased visual acuity and depth perception, sarcopenia (muscle mass loss of 3-8% per decade after age 30), and slowed neuromuscular reaction time. Orthostatic hypotension (failure of baroreceptor-mediated vasoconstriction during position change) affects 30% of adults over 70. Gait changes include shortened stride length, wider base, reduced arm swing, and increased postural sway. Falls are the leading cause of injury-related death in adults >65, with hip fracture carrying 20-30% one-year mortality. Each fall increases the fear of falling, leading to activity restriction, deconditioning, and increased subsequent fall risk.
Diagnosis & workup
Diagnostics & workup: - Perform Timed Up and Go (TUG) test: >12 seconds indicates increased fall risk - Assess orthostatic vital signs (supine, then standing at 1 and 3 minutes) - Screen vision (Snellen chart) and refer for ophthalmologic evaluation - Review all medications for fall-risk contributors - Assess cognitive function (MMSE or MoCA) - Order vitamin D level - Assess footwear and use of assistive devices - Order bone density scan (DEXA) in patients with fall risk