Intrinsic Factors

Balance and ambulation require a complex interplay of cognitive, neuromuscular and cardiovascular function and a rapid adaptation to the environmental challenge.

Gait and balance disorders or muscle weakness are a major predisposing factors for falling. Changes in muscle strength, reflex time, and balance with aging are partially responsible for this.² For instance, aging is associated with a decrease in the ability of an individual to control for changes in his or her body position, due to a reduction in nerve conduction velocity, muscle force speed, and changes in range of motion of joints.¹² Deconditioning may occur due to prolonged bedrest or limited physical activity. Aging is associated with certain alterations in gait, including a decrease in step height and stride length, which may decrease stability. Abnormalities in sensory, neurologic, and musculoskeletal function may contribute to falls.³

Dizziness or vertigo is commonly reported by elderly individuals as associated with a falling episode.² It is important to distinguish if the patient experienced "vertigo" (a rotating sensation), which implies a disorder of the central nervous system or vestibular apparatus, as opposed to "lightheadedness," which may imply a cardiovascular problem, orthostatic hypotension, or a drug side effect.¹⁰

Confusion and/or cognitive impairment can impair judgment, visual-spatial perception, ability to orient oneself, and lead to a tendency for an individual to wander or attempt to get out of wheelchairs or climb over bed siderails.² Confusion may be a result of an acute illness (such as a fever or electrolyte disturbance) or dementia.³ Falling is actually a well-recognized nonspecific presenting event for many acute illnesses in elderly individuals.

Medications Associated with Falling

Therapeutic Classes of drugs  Antidepressants  Sedative/Hypnotics  Vasodilators/Antihypertensives  Non-Steroidal Antiinflammatory agents  (NSAIDs) Antipsychotics Diuretics

Numerous studies have evaluated the relationship between medication use and falls and fractures, with somewhat conflicting results. The determination of a cause-and-effect relationship is made difficult by coexisting diseases and combinations of medications. Some medications that have been implicated in increasing the risk of falling are listed here.¹¹-¹³ In addition, a higher risk of falls has been associated with an increasing number of medications used.³

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