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Assessing Risk for Falls in Neurology Patients

Certain neurologic conditions may increase the risk for falls in older patients.

About one third of community-residing adults older than 65 fall each year. In older adults, falls result in major adverse outcomes, including injury, immobility, hospitalization, institutionalization, and death. Many neurologic diseases are associated with a high risk for falls. The authors conducted an evidence-based review of 86 studies to develop these American Academy of Neurology Practice Parameters on screening for risk for falls in patients seen in neurology practices.

The authors found good-quality evidence to suggest that the risk for falls is increased in people with diagnoses of stroke or dementia, histories of previous falls, or disorders of gait and balance. They found weaker evidence of increased risk for falls in patients with Parkinson disease, peripheral neuropathy, weakness or sensory loss in the lower extremities, and major visual loss. Although many screening tools to assess risk for falls have been proposed, the authors found insufficient evidence to support the use of any screening beyond that provided by a standard neurologic examination. They recommend that clinicians ask all patients with neurologic diseases associated with risk for falls about falls in the previous year and provide a comprehensive neurologic examination that focuses on tests of cognition, balance, and gait, as well as strength, sensations, and coordination in the lower limbs.

Comment: Too few studies have systematically examined risk factors, screening measures, and interventions for falls in neurologic patients. This well-conducted review identifies specific neurologic diseases and abnormal neurologic signs that may indicate increased risk for falls. The review also highlights gaps in our knowledge regarding this important health outcome. There is a clear need to build on these findings and recommendations and to develop quick and efficient clinical screening tools to assess risk for falls.

— Joe Verghese, MD

Dr. Verghese is Associate Professor of Neurology, and Director, Division of Cognitive & Motor Aging, Albert Einstein College of Medicine, Bronx, NY.

Published in Journal Watch Neurology April 8, 2008

Citation(s):

Thurman DJ et al. Practice Parameter: Assessing patients in a neurology practice for risk of falls (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2008 Feb 5; 70:473.

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