Falls in older persons: causes and interventions

Article Abstract:

Falls suffered by older persons often lead to serious injury. The "fear of falling" inhibits many elderly persons from engaging in normal activities, resulting in a decrease in physical activity levels and loss of physical conditioning. Falls accounted for 33 percent of deaths among persons aged 65 years and over. While precise figures are not available, between six and 10 percent of falls by older people are cited as resulting in injury, with women being more likely to suffer falls than men. Prevention is the best means of reducing fall-related injuries, since there is no means to predict which falls will lead to an injury. The first step in prevention is to assess the individual's physical and mental condition and the environment in which he or she routinely lives. It is important to make an assessment of judgment, vision, hearing, strength, neurologic and cardiovascular status, and the use of medications. There are some important factors that increase the likelihood that an elderly persons will fall: any change in sensory or motor status may lead to a fall by altering an individual's gait or balance; use of more than one medication often impairs sensory perception, alters gait, and affects balance; certain types of drugs, particularly hypnotics, tranquilizers, antihypertensives, and sedatives, increase the likelihood of a fall in an elderly person. Environmental factors such as faulty stairs, loose throw rugs, slippery or icy surfaces, poor lighting, and unexpected objects pose significant risks. After identifying risks associated with the elderly person and the environment, it is important to promote interventions that will reduce the risk of falling: determining whether there are any underlying diseases; changing medications; promoting exercise; making regular assessment of dangers in the environment; and promoting physical therapy combined with gait and balance training.

Aging, Injuries, Prevention, Home accidents, Falls (Accidents) in old age

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Perceived quality of life and preferences for life-sustaining treatment in older adults

Article Abstract:

Physicians' decisions to initiate life-sustaining treatment are often based on perceptions of their patients' quality of life, but evidence indicates that physicians' perceptions may often differ from those of their patients. Since many patients are often too ill to make decisions to begin such treatment, physicians must make these decisions for them. Thus, it is crucial that physicians' perceptions of quality of life match their patients' perceptions. In a survey of 105 physicians and 258 of their patients, the doctors and patients were both asked to estimate the patients' quality of life. The doctors were also asked to indicate their preferences for initiating cardiopulmonary resuscitation (CPR) or mechanical ventilation if necessary, and the patients were asked whether they would ever wish to receive such treatment. The physicians judged the patients' quality of life to be worse than the patients themselves did. In addition, the physicians' ratings of the patients' quality of life were positively associated with their preference for beginning CPR or ventilation. But the patients' ratings of their quality of life were less inclined to be associated with their willingness to receive these treatments. In other words, the physicians would be more likely to begin CPR or mechanical ventilation if their assessment of the quality of life was favorable. However, their patients may not feel the same way, and the physicians' decisions to begin life-sustaining treatment may not be in agreement with the patients' desires. This emphasizes the need for caution on the part of physicians when ordering life-sustaining treatment for patients who may be too ill to make decisions for themselves. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Evaluation, Physician and patient, Physician-patient relations, Artificial respiration, Mechanical ventilation, Beliefs, opinions and attitudes, Quality of life, CPR (First aid), Cardiopulmonary resuscitation

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