Risk Factors Continued
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We can think of risk factors in several ways
Intrinsic risk factors
- history of falls
- comorbidities (eg, Parkinson disease, diabetes)
- balance issues
- decreased hearing
- gait instability
- recurrent falls
Extrinsic risk factors
- environment
- lighting
- medication
- footwear
- time of day (afternoon is the most high-risk time)
- more falls in winter and during the day
NOTE
Reasons why ED patients present after a fall have also been studied. In a review of the article “Will my patient fall?” (Ganz JAMA 2007), researchers analyzed a common set of risk factors identifiable during a routine clinical exam that predict future falls. The conclusion was that the most positive likelihood ratios that predicted if a patient would fall were related to medication use (especially of benzodiazepines), dementia, Parkinson disease, and history of stroke. However, this was not an ED-based study.
References
Carpenter CR et al Acad Emerg Med. 2009;16(3):211–219.
Carpenter CR. Ann Emerg Med. 2009;53(3):398–400.
Bueno-Cavanillas A et al. Eur J Epidemiol. 2000;16(9):849–859.
Ganz DA et al. JAMA. 2007;297(1):77–86.