Management of Patients with Recurrent Falls

Assessment

The American Geriatrics Society recommends that all older persons should be asked at least once a year about falls 1
Patients who report recurrent falls should undergo a comprehensive fall evaluation, including history of fall circumstances, medications, acute/chronic medical problems, and mobility levels 1, 2
The "Get Up and Go Test" should be performed to assess mobility and balance 1
A comprehensive fall evaluation should include examination of vision, gait, balance, and lower extremity joint function, as well as a basic neurological examination 1

The American Geriatrics Society recommends gait training and advice on appropriate use of assistive devices for community-dwelling older adults 1, 3
Review and modification of medications, especially psychotropic medications and those taking four or more medications, is recommended 3, 4
Exercise programs with balance training as a key component can reduce falls 3
Modification of environmental hazards, such as removing tripping hazards and improving lighting, can reduce falls 3, 5

The American Geriatrics Society recommends offering long-term exercise and balance training to older people with recurrent falls 3
Tai Chi is a promising balance exercise, though requires further evaluation 3
Review and modification of medications, particularly psychotropic drugs, can reduce fall risk 3, 4
Treatment of postural hypotension and cardiovascular disorders can reduce fall risk 3

Patients and families should be counseled about the risk of falls and recurrence, and educated about home safety, activity restrictions, and supervision needs 6
Recurrence rates increase over time, reaching up to 36%, emphasizing the importance of follow-up after diagnosis 6

Relying solely on fall risk screening without implementing targeted interventions can be ineffective 5
Overlooking medication review, especially psychotropic medications, can increase fall risk 3, 4
Failing to address multiple risk factors in high-risk individuals can reduce the effectiveness of interventions 1, 3