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Falls among the older population have massive economic and clinical implications for the healthcare system. Falls cost the NHS about £15m ([euro]17m; $23m) a year. 1 More than 400000 patients presenting to emergency departments in the United Kingdom have had falls, 2 and they require multidisciplinary management from cardiology to urology to social services. The problem of falls in older people will grow as people live longer and the older population increases. It is important that doctors can adequately assess, treat, and manage an older patient who has fallen and are aware of current legislation surrounding the prevention of falls (box 1).
Box 1: Current legislation in the UK
The National Service Framework for Older People guidelines 2 were introduced in 2001 and are aimed at improving the quality of care for the older UK population. Nearly 10 years on, their eight key standards should be well established and implemented across health trusts. Standard six is aimed at fall prevention. The aim is to reduce the number of falls that result in serious injury and to ensure effective treatment and rehabilitation for those patients.
National Service Framework standards
(1) Rooting out age discrimination
(2) Person centred care
(3) Intermediate care
(4) General hospital care
(5) Stroke
(6) Falls
(7) Mental health
(8) Promotion of health and active life in old age
Taking a history and examination
When taking the history and examining the patient, ask yourself why this person fell at the time they did and in the place they did. 3 The key to establishing what caused the fall and the likelihood of a fall occurring again includes the history from the patient with a collateral history from family, carers, or friends. The mnemonic CATASTROPHE is a good aid that covers many of the main risk factors for falling (box 2). 4
Box 2 CATASTROPHE mnemonic for taking a history for falls
C-caregiver and housing
A-alcohol (including withdrawal)
T-treatment (drugs, and consider compliance)
A-affect (depression or lack of initiative)
S-syncope (any episodes of fainting)
T-teetering (dizziness)
R-recent illness
O-ocular problems
P-pain with mobility
H-hearing (needed to avoid hazards)
E-environment hazards
Physiological assessment requires appropriate examination of the cardiovascular, neurological, musculoskeletal, and visual systems. In the cardiovascular system examination you should aim to rule out...