Instability and falling in elderly patients.

Falls and instability in elderly patients may result from a single disease process or from the accumulated effect of multiple diseases and impairments. Therefore the first step in evaluating an elderly patient with a history of falling or instability is to identify single, potentially treatable diseases, such as normal pressure hydrocephalus, cervical spondylosis, or lumbar stenosis. The next step, regardless of whether or not a single disease process is identified, is to determine all factors possibly contributing to instability. This step involves a careful history and examination using the checklist approach already described. Careful recreation of the fall situation including location, activity engaged in, how the patient was feeling, and any environmental hazards present is an important part of the fall history. Re-creating the fall situation may provide important clues toward etiology as well as prevention. Interventions aimed at ameliorating identified impairments should be considered. Obviously, interventions need to be considered within the context of overall patient health and well-being rather than merely fall prevention. Fall preventive interventions may be medical, surgical, rehabilitative, or educational, or may involve environmental manipulations. Examples include surgery and good lighting for subjects with cataracts, adaptive footwear or surgery for patients with severe foot deformities, or physical therapy, appropriate walking aids, and raised seats for subjects with difficulty or unsteadiness in getting up. Instability and falling are not inevitable accompaniments of aging, but are problems that result from identifiable disabilities and impairments.(ABSTRACT TRUNCATED AT 250 WORDS)