[Diagnosis of the risk of accidental falls in the elderly]

The steep increase in the incidence of hip fractures and other fall-related fractures with advancing age is caused by an age-associated combination of increased fall frequency, typical fall mechanisms and reduced bone strength. This article reviews the current knowledge related to fall risk factors and fall mechanisms. Non-syncopal falls during normal daily activities are predominantly age-associated occurrences with serious consequences. 5% of all falls cause fractures, another 10 to 15% lead to a variety of further injuries. The most serious consequences of the geriatric fall syndrome are fractures of hip, humerus, wrist and pelvis. Fear of falling and self limitation of physical activity are self imposed psychological impairments. There is a pathological cascade from age-associated gait and balance disorders to locomotor falls and further to fall-related fractures. Significantly increased fall risk caused by gait and balance disorders can be considered as a distinct chronic pathological condition. It is strongly age-related and definitely has a multifactorial origin. The term "age-associated multifactorial gait disorder" has been coined for this condition. Assessing fracture risk requires evaluating fall risk, fall mechanisms and bone strength. Older people with gait and balance disorders fall mostly sideways, and the impact of such a fall from standing height generates enough force to break an older non-osteoporotic femur. Osteoporosis can decrease bone strength beyond the age-related grade, and is one of the several most important risk factors for fractures. Prospective studies have consistently found the following independent risk factors for non-syncopal falls: 1. Muscle power of lower extremities, 2. Lateral postural stability, 3. Clinical evaluation of gait, 4. Visual impairment, 5. Four or more different medications or certain psychotropic drugs, 6. Cognitive impairment, and 7. History of falling. The fall-related neuromuscular status can be adequately assessed by three diagnostic procedures: The chair rising test represents muscle power, and has proven its relevance for both fall risk and deterioration of mobility and functional independence. Measurement of lateral postural stability can be done by tandem manoeuvres. Clinical evaluation of gait should focus on the regularity of gait as a cyclic event. The fall risk status of an individual depends strongly on the number of the independent risk factors that one accumulates. Both prevention and therapy must focus on each of these individual risk factors. Preventing falls and its consequences is imperative for successful aging.