Geriatric Falls
• Epidemiology:
     -Falls are the most common cause of traumatic mortality in geriatric patient
     -Of patients admitted to hospital, 33% will be dead within 1 year

• Mechanism:
     - Syncope and seizure must be considered in patients without a clear history of mechanical fall
     - In pure mechanical fall patients think about:
            Metabolic problems → mild hyponatremia increases risk for fall eight-fold
            Medications → benzo’s are #1 v. anticholinergics v. TCA v. muscle relaxants v. anti-epileptics
            Frailty and risk factors:
               • Inability to cut own toenails
               • Any fall in past 12 months
               • Self-reported depression
               • Presence of non-healing foot sore

• Approach to Geriatric Falls: 
     - Follow standard trauma teachings using clinical gestalt and ATLS
     - Think about why the patient fell
     - Consider checking for hyponatremia especially in patients with CHF, CKD, cirrhosis, and SIADH
     - Medication reconciliation is a great opportunity to prevent morbidity/ mortality from future falls
     - Assess risk of future falls and frailty per above and incorporate a risk assessment tool like the “Timed Get Up and Go Test”

References:
• http://rebelem.com/secondary-fall-prevention-in-geriatric-patients/
• Carpenter, Christopher R., et al. “Predicting geriatric falls following an episode of emergency department care: a systematic review.” Academic emergency medicine 10 (2014): 1069-1082. PMID 25293956