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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.
All patients older than 65 years and any patient presenting with an acute fall should undergo screening for their risk of falls.
The mini balance evaluation systems test, functional gait index, and Berg Balance Scale all have normative age-graded values to predict fall risk.
CASE
Mr. J was referred for balance assessment and to a rehabilitation program. He underwent balance physiotherapy, including multifactorial balance assessment, joined a community exercise program, was fitted with hearing aids, and had his home environment optimized by an occupational therapist. (See examples of “home safety interventions” under “Preventing falls in primary care.”)
Exercise programs should be designed around an accurate functional baseline of the patient to avoid underdosed strength training.
3 months later. Mr. J says he feels stronger on his feet. His knee pain has eased, and he is more confident walking around his home. He continues to engage in exercise programs and is comfortable running errands with his spouse.
CORRESPONDENCE Jason A. Beyea, MD, PhD, FRCSC, Division of OtolaryngologyHead and Neck Surgery, Queen’s University, 144 Brock Street, Kingston, Ontario, Canada, K7L 5G2; jason.beyea@queensu.ca
