P12 - When a Fall Is More than Just a Fall: Case Studies in Falls as a Prodrome for Underlying Pathology in Older Adults

According to the CDC, one in three older adults fall each year, and every 13 seconds an older adult is treated in the emergency room from a fall. Nearly 50% of cases when falls were a presenting complaint were found to be associated with another diagnosis. A fall may represent geriatric physiological changes such as orthostatic hypotension related to baroreceptor response and a decrease arterial compliance. Functional decline leading to a fall could signify progressive weakness such as that associated with decompensated heart failure or a malignancy.

A significant illness in the older adult can manifest itself with a ground level fall as the initial presenting symptom. Underlying reasons for falls in the older adult may include electrolyte abnormalities (such as hyponatremia or hypercalcemia) or malignancies such as multiple myeloma, infections, or septicemia. A fall may be the consequence of a neurological event a cerebrovascular accident or normal pressure hydrocephalus or seizure disorder may result in. Volume depletion and dehydration can potentiate antihypertensive actions leading to fall or near fall. Older adults are susceptible to cardiovascular events including acute coronary syndrome, rhythm abnormalities (heart block, atrial fibrillation, sick sinus syndrome), or valvular disease (rheumatic heart disease, mitral valve regurgitation, or aortic stenosis) that may be a precursor to a fall.

The purpose of this presentation intends to provide the participant with unfolding case discussions of older adults who have experienced a fall. Exposing the processes of building the differentials related to potential underlying causes will include incorporating domains of a comprehensive geriatric assessment. Interactive imbedded questions will enhance the learning experiences including diagnostic testing, analysis of symptoms, and medication review. In order to identify potentially life-threatening illness in this population, it is necessary to apply advanced assessment skills to determine physiological findings and the age-related changes that underly them. Gerontological advanced practice nurses in acute, primary, and long-term care have an opportunity to showcase their investigative skills while educating patients and carers to report promptly any decline in function or fall to their care team.