EM · Geriatric and special-population emergencies

Geriatric falls and immobility

Also known as Falls in the elderly · Older person fall · Recurrent falls · Mechanical fall · The long lie · Immobility and deconditioning

Geriatric falls and immobility — the multifactorial geriatric syndrome in which an older person comes to rest unintentionally on the ground, and the spiral of deconditioning that follows. Falls affect more than a quarter of community-dwelling over-65s each year, rising with age, and they are the leading cause of injury-related morbidity and mortality in older adults. The ED assessment is the multifactorial search: orthostatic vital signs, gait (a prolonged Timed Up and Go), cognition (the 4AT, score 4 or more is probable delirium), the drug chart (STOPP/START and the fall-risk-increasing drugs — benzodiazepines, antipsychotics, opioids, antihypertensives), and vision. Investigation targets the consequence — a hip X-ray for the fractured neck of femur and a CT head for the head strike, where age 65 or over is itself a Canadian CT Head Rule criterion. Management treats the precipitant, fixes the fracture (the femoral nerve block and early surgery), deprescribes the culprit drugs, and layers on physiotherapy, an occupational therapy home visit, and vitamin D for the deficient. The differential is syncope, occult sepsis, and stroke — the masked infective fall and the unwitnessed collapse with amnesia are the traps. ACEM-primary, globally tagged.