Clinical assessment of the elderly who fall

Abstract

Aging can cause changes that negatively impact the balance as well as the gait, thereby increasing the vulnerability of the elderly to falls. Many seniors do not report difficulty walking during a medical appointment; some do not mention having already fallen because they feel that this is part of normal aging or they are not aware of interventions that can mitigate the problem. Postural instability is considered a geriatric syndrome with signs and symptoms of their own and multifactorial etiology.

A fall in an elderly individual can be considered a sentinel event or a warning sign announcing a functional decline, an asymptomatic infection, the adverse effect of a drug or an underlying pathology without classic signs and symptoms. Physical examination of an elderly begins even before entering the office. The physician should be alert to the way they rise from the chair and walk, if they need help to stand or use any device to assist walking.

The assessment of balance and gait alterations as well as the investigation of the occurrence of falls in the elderly should be made very carefully: during the clinical interview, the doctor should directly ask about issues involving balance, gait and the occurrence of falls and find out the circumstances in which they occurred.

Usually falls are a consequence of balance and gait disturbances and some of them are typical of specific pathologies, therefore, careful observation of the gait can help the physician to develop diagnostic hypotheses most likely to be correct in order to propose preventive interventions.