Thesis defense Yvonne Schoon (Donders Series 132)

14 october 2013

Promotor: Prof.dr. M.G.M. Olde Rikkert,  copromotors: dr. J.A.H.R. Claassen, dr. R.j.F. Melis

From a Gait and Falls Clinic Visit Towards Self-Management of Falls in Frail Elderly

Falling in the elderly is a common health problem; one third of all community-dwelling elderly above 65 years of age, fall at least once a year. Falling is a geriatric syndrome, as the causal pathway of falling among older people is dominantly multifactorial.

We examined the patient characteristics and fall-risk profiles of two groups visiting an academic multidisciplinary falls clinic. In clinical practice, the selection of a specific referral method and subsequent evaluation of the selection process strongly contributes to the effectiveness and efficiency of a falls clinic.

Hypotensive syndromes (prevalence 51-64%) and cognitive impairment (prevalence 43%) are common in falling elderly. Episodic hypotension does not appear to increase cognitive impairments in falling (i.e., frail) elderly.  Head-turning can induce hypotension and was prevalent in 39% of the falls clinic population and  was associated with carotid sinus hypersensitivity (odds ratio 3.5).

Self-management of falls may be possible by measuring individuals fall risk using a simple mobility test. The diagnostic value of three mobility tests (maximum step length, gait speed, and chair rise) for frailty was investigated in 593 community-dwelling elderly people. The predictive values for falls using the maximum step length and gait speed tests were low and slightly better for recurrent falls. A higher maximum step length score indicated a lower likelihood of an older participant falling, with a hazard ratio of 0.36.