Risk factors for loss of balance

Falls in the elderly have a multifactorial origin. The greater the number of risk factors, the greater the probability of falls, but the relationship is not additive, but multiplicative; that is, each cause or risk factor enhances the effect of the others.

For this reason, it is important to comprehensively and adequately assess the elderly person and their environment, in order to correctly consider the risk of a fall in the elderly and to be able to offer individualized solutions and recommendations.

To simplify, the causes of falls are divided into intrinsic and extrinsic to the individual, or those that are specific to the person and those that belong to their environment.

The intrinsic causes are

Physiological changes related to age:

• Eye disorders decreased visual acuity
  • decreased accommodation capacity
  • presbyopia (near vision problems)
  • decreased tolerance to bright light (glare)
  • abnormal depth perception (problems with stairs, for example ...)
• Auditory disturbances
  • presbycusis (decreased hearing ability, making it difficult to assess the environment.)
• Alterations of the nervous system (together with hearing problems cause balance disturbances)
  • slowing of reaction time and reflexes
  • decreased proprioceptive sensitivity (how each part of the body is positioned)
  • alteration of vestibular nerve conductivity (slowing of the reaction of the balance apparatus).
• muscle and soft tissue atrophy

Diseases that predispose to falls

cardiovascular pathologies:

• acute myocardial infarction
• orthostatic hypotension, caused by:
  • autonomic neuropathy (diabetes mellitus, alcoholism)
  • stroke
  • Parkinson's disease
  • drugs: benzodiazepines, neuroleptics, diuretics,
  • vasodilators, tricyclic antidepressants
  • hypovolemia: hidden bleeding, dehydration
  • heart failure
  • prolonged bedding
• Syncope, caused by:
  • arrhythmias, heart block, bradycardia (first cause in people over 65 years)
  • Vasovagal syncope due to coughing, urination, hyperventilation, defecation (second most common cause in people over 65 years of age)
  • aortic stenosis
  • pulmonary embolism
  • severe anemia
  • Metabolic disorders (hypoglycemia)
  • epileptic seizures

Gait disorders

• musculoskeletal origin
  • atrosis: knee, hip
  • sequelae of fractures
  • foot problems (hallux valgus or bunions, mainly)
• neurological in origin
  • frontal origin (apraxia or "forgetfulness" of the gait mechanism)
    • normal pressure hydrocephalus
    • dementia
    • Multiple strokes
  • parkinsonism
  • cerebellar degeneration
  • peripheral origin
    • neuropathies
    • multiple sensory deficits
    • cervicoarthrosis
    • vitamin B12 deficiency
  • Vertigo
    • peripheral (diseases of the balance apparatus)
    • central (cerebellar lesions)
  • Visual system diseases
    • glaucoma
    • waterfalls
    • macular degeneration
  • Other acute systemic illnesses (any unexplained falls may be a sign of impending serious illness)
    • infections: mainly urinary, respiratory and biliary origin
    • endocrinometabolic disorders: dehydration, hypokalaemia, hyponatraemia, hypoglycemia.
  • Drugs: the greater the number of drugs, the greater the risk of falls; are related to these by:
    • hypotensive effect: antihypertensive
    • sedative effect: benzodiazepines, antidepressants, neuroleptics, anticonvulsants.
  • Interactions and other adverse effects,

Regarding extrinsic causes, it is worth highlighting:

• Bath
  • Slippery shower or tub
  • No grippers
  • Low toilet bowl
• Bedroom
  • Bed too high
  • Bathroom away
  • Absence of bars in the bed (in large dependents)
• Clothing
  • Open footwear
  • Wide clothes
  • Trousers too long
• illumination
  • Excessive glare
  • Bad lighting
• I usually
  • Slippery or wet
  • Badly fixed carpets
  • Objects that cause tripping in the places of passage
• Ladders
  • No grippers
  • High and worn steps
• Others
  • chairs too low
  • absence of arms in the chairs
  • poorly used walking aids Stairs