Falls in Geriatrics

Introduction

Falls are a significant health concern for older adults in Canada, impacting both quality of life and healthcare resources. This comprehensive guide is designed to help Canadian medical students prepare for the Medical Council of Canada Qualifying Examination Part I (MCCQE1) by covering key aspects of falls in geriatrics, with a focus on Canadian healthcare practices and guidelines.

Epidemiology in the Canadian Context

Understanding the prevalence and impact of falls in Canada is crucial for MCCQE1 preparation:

• Falls are the leading cause of injury-related hospitalizations among Canadian seniors
• Approximately 20-30% of Canadian seniors experience at least one fall each year
• Falls account for 85% of injury-related hospitalizations in seniors aged 65 and older in Canada
• The economic burden of falls in Canada is estimated at $6.7 billion annually

Risk Factors for Falls

Identifying risk factors is crucial for fall prevention. Canadian healthcare providers should be aware of the following:

Assessment of Falls Risk

Canadian healthcare providers should conduct comprehensive fall risk assessments using validated tools. The MCCQE1 may test your knowledge on these assessment methods:

Fall Prevention Strategies

Implementing effective fall prevention strategies is a key component of geriatric care in Canada:

1. Exercise Programs:

   • Tai Chi and balance training have shown efficacy in Canadian studies
   • Strength and flexibility exercises

2. Medication Review:

   • Regular review and adjustment of medications, especially psychotropics
   • Consider deprescribing when appropriate

3. Home Modifications:

   • Installation of grab bars and handrails
   • Improved lighting
   • Removal of tripping hazards

4. Vision Correction:

   • Regular eye examinations
   • Updating eyewear prescriptions

5. Vitamin D Supplementation:

   • Particularly important in Canada due to limited sun exposure in winter months

6. Multifactorial Interventions:

   • Combining multiple strategies for comprehensive fall prevention

Canadian Guidelines for Fall Prevention

Familiarity with Canadian guidelines is essential for MCCQE1 success:

1. Canadian Task Force on Preventive Health Care (CTFPHC):

   • Recommends exercise interventions to prevent falls in community-dwelling adults aged 65 years and older
   • Suggests multifactorial assessment and intervention for those at high risk of falls

2. Public Health Agency of Canada (PHAC):

   • Promotes the "Finding Balance" program, which focuses on education and awareness

3. Canadian Patient Safety Institute (CPSI):

   • Advocates for the implementation of fall prevention strategies in healthcare settings

4. Osteoporosis Canada:

   • Recommends vitamin D supplementation and exercise for fall prevention in older adults

Management of Falls

When falls occur, proper management is crucial:

Key Points to Remember for MCCQE1

1. Falls are a leading cause of injury and hospitalization in Canadian seniors
2. Comprehensive fall risk assessment includes history, physical examination, and environmental evaluation
3. Canadian guidelines emphasize exercise interventions and multifactorial approaches for fall prevention
4. Vitamin D supplementation is particularly important in the Canadian context
5. The Canadian Fall Prevention Curriculum (CFPC) is a nationally recognized program for healthcare professionals
6. Management of falls includes immediate response, medical evaluation, treatment, rehabilitation, and follow-up
7. Familiarity with Canadian-specific programs like "Finding Balance" is important for the MCCQE1 exam

MCCQE1 Practice: Fall Prevention Mnemonic

Remember key fall prevention strategies with this Canadian-focused mnemonic:

C.A.N.A.D.A. F.A.L.L.S.

• Comprehensive assessment

• Assistive devices review

• Nutrition and vitamin D

• Activity and exercise

• Drug review

• Awareness education

• Footware evaluation

• Adaptation of home environment

• Lighting improvement

• Low-risk medications

• Strength and balance training

Sample Question

A 75-year-old woman presents to her family physician for a routine check-up. She mentions that she has fallen twice in the past six months, once while getting out of bed at night and once while walking on an icy sidewalk. She lives alone in a two-story house and takes medication for hypertension and osteoarthritis. Which one of the following interventions is most appropriate as the first step in reducing her risk of future falls?

• A. Prescribe a walking aid
• B. Recommend moving to a single-level dwelling
• C. Conduct a comprehensive fall risk assessment
• D. Start vitamin D supplementation
• E. Refer for physiotherapy

Explanation

The correct answer is:

• C. Conduct a comprehensive fall risk assessment

Explanation: In this scenario, conducting a comprehensive fall risk assessment is the most appropriate first step. This aligns with Canadian guidelines for fall prevention in older adults. The assessment would include:

1. Detailed history of falls
2. Medication review
3. Evaluation of gait and balance
4. Assessment of home environment
5. Review of medical conditions

This comprehensive approach allows for identification of specific risk factors and tailoring of interventions. While other options like vitamin D supplementation or physiotherapy may be beneficial, they should be recommended based on the results of the initial assessment. This approach is consistent with the Canadian Task Force on Preventive Health Care recommendations and is a key concept for MCCQE1 preparation.

References

1. Public Health Agency of Canada. (2014). Seniors' Falls in Canada: Second Report. https://www.canada.ca/en/public-health/services/health-promotion/aging-seniors/publications/publications-general-public/seniors-falls-canada-second-report.html (opens in a new tab)

2. Canadian Task Force on Preventive Health Care. (2018). Recommendations on the prevention of falls in community-dwelling older adults. https://canadiantaskforce.ca/guidelines/published-guidelines/falls-prevention/ (opens in a new tab)

3. Osteoporosis Canada. (2021). Exercise for Healthy Bones. https://osteoporosis.ca/bone-health-osteoporosis/exercise-for-healthy-bones/ (opens in a new tab)

4. Canadian Patient Safety Institute. (2020). Falls. https://www.patientsafetyinstitute.ca/en/Topic/Pages/Falls.aspx (opens in a new tab)

5. Scott, V., Wagar, L., & Elliott, S. (2010). Falls & Related Injuries among Older Canadians: Fall-related Hospitalizations & Prevention Initiatives. Prepared on behalf of the Public Health Agency of Canada, Division of Aging and Seniors. Victoria BC: Victoria Scott Consulting.