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Applied Evidence
How to identify balance disorders and reduce fall risk
Division of Otolaryngology/Head and Neck Surgery, Department of Surgery, Queen’s University School of Medicine, Kingston, (Drs. Newsted and Jason A. Beyea); Physiotherapy Outpatient Services, Providence Care Hospital, West Kingston (Mr. Bale); Quinte Hearing Centre, Belleville/Picton (Ms. Armstrong); Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, and Department of Critical Care, William Osler Health System, Brampton (Dr. Michael M. Beyea); Department of Family Medicine, Queen’s University School of Medicine, Kingston (Dr. Simpson); Division of Geriatric Medicine, Department of Medicine, Queen’s University School of Medicine, Kingston (Dr. Gill); ICES Queen’s, Queen’s University, Kingston (Drs. Gill and Jason A. Beyea), Ontario, Canada jason.beyea@queensu.ca
Dr. J.A. Beyea discloses that he has a proprietary interest in Kingston Ear Institute Inc., which is a multidisciplinary clinic that provides diagnostic and therapeutic services for hearing, balance, and vestibular loss. Ms. Armstrong discloses a proprietary interest in Quinte Hearing Centre, which is a clinic that provides diagnostic and therapeutic services for hearing loss.
The other authors reported no potential conflict of interest relevant to this article.
An approach to preventing falls includes the development of individualized programs that account for frailty, a syndrome of physiologic decline associated with aging. Because frailty leads to diminished balance and mobility, a patient’s frailty index—determined using the 5 frailty phenotype criteria (exhaustion, weight loss, low physical activity, weakness, slowness)82 or the Canadian Study of Health and Aging Clinical Frailty Scale83—is a useful tool for predicting falls risk and readmission for falls following trauma-related injury. Prevention of falls in communities is critical for reducing mortality and allowing older people to maintain their independence and quality of life.
Exercise.In some areas, exercise and falls prevention programs are accessible to seniors.84 Community exercise programs that focus on balance retraining and muscle strengthening can reduce the risk of falls.73,85 The Choosing Wisely initiative of the ABIM [American Board of Internal Medicine] Foundation recommends that exercise programs be designed around an accurate functional baseline of the patient to avoid underdosed strength training.54
Multifactorial risk assessment in high-risk patients can reduce the rate of falls. Such an assessment includes examination of orthostatic blood pressure, vision and hearing, bone health, gait, activities of daily living, cognition, and environmental hazards, and enables provision of necessary interventions.73,86 Hearing amplification, specifically, correlates with enhanced postural control, slowed cognitive decline, and a reduced likelihood of falls.87-93 The mechanism behind improved balance performance might be reduced cognitive load through supporting a patient’s listening needs.88-90
Pharmacotherapy. Optimizing medications and performing a complete medication review before prescribing new medications is highly recommended to avoid unnecessary polypharmacy7,8,18,53-56 (TABLE 17-56).
Management of comorbidities associated with a higher risk of falls, including arthritis, cancer, stroke, diabetes, depression, kidney disease, chronic obstructive pulmonary disease, cognitive impairment, hypertension, and atrial fibrillation, is essential.94-96
