Fall proneness (synonyms: fall proneness n.e.c.; fall proneness due to other unclear disease states; fall proneness in the elderly; ICD-10 R29.6: fall proneness, not elsewhere classified) plays a major role, especially in geriatrics (the study of diseases of the aging person).
According to the DEGAM guideline, a fall is defined as follows: “An involuntary, sudden, uncontrolled falling or sliding of the body to a lower level from standing, sitting or lying down. Such an event is also considered a fall or near fall if it is prevented only by unusual circumstances not inherent in the patient, such as being caught by another person.
Common causes of a tendency to fall include dizziness and gait instability in the elderly:
- Deficits in peripheral and central sensory functions (vestibular, visual, somatosensory).
- Cognitive and mental disorders (e.g., mild cognitive impairment/dementia; anxiety, depression).
- Musculoskeletal insufficiencies (sarcopenia, osteoarthritis, rheumatoid arthritis).
Another cause of a fall may be syncope (brief loss of consciousness caused by reduced blood flow to the brain, usually accompanied by a loss of muscle tone). See syncope for more information. Majority of falls occur without preceding loss of consciousness.
The following forms of falls can be distinguished:
- Afferent disorder – fall due to failure of sensory, optical or vestibular impressions (concerning sense of balance).
- Drop attacks (“fall attack”) – sudden fall event with unclouded consciousness as a result of loss of tone in the lower extremities.
- Gait freezing – fall due to freezing of movement.
- Mechanical falls such as tripping or slipping.
- Weakness/fragility – falls caused by lack of muscle strength.
- Overturning – falls caused by postural problems.
A tendency to fall can be a symptom of many diseases (see under “Differential diagnoses”).
Frequency peak: the rate of falls and therefore the risk of injury increase with age:
- In > 65-year-olds, the rate of falls is 30%.
- In > 80-year-olds it is > 50 % – every 10th has injury consequences requiring treatment and every 20th fracture consequences
Up to 80% of cases are domestic falls. Approximately one-sixth of all emergency admissions of older people in hospitals are due to falls (in Germany).
Gender ratio: Women are more frequently affected than men.
The prevalence (frequency of illness) is about 30% for those over 65 years of age in any given year. The rate continues to increase with age. Among those aged 80 to 89, approximately 40 to 50 percent are affected.
Course and prognosis: Injuries occur in up to 30% of cases. Frequent injuries are abrasions, hematomas (bruises) or fractures (broken bones). Up to 70 percent of those who fall fall again within the following 12 months. After a fall-related fracture (especially femoral neck fracture), only about 15 percent of patients can walk independently without aids. Before the fall, about three quarters of the patients were able to move independently without aids. In addition to treating the cause, the focus is on developing treatment strategies to prevent further falls.
