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The recommendations of Dr Vassallo and his colleagues (June 2004 JRSM1) for prevention of falls in patients with unsafe gait, by simple risk stratification and targeting, seem a notably practical option. They identify confusion and previous falls as the main predictors. It is important to highlight that most of the patients in the study were elderly (mean age 82 years).
Falls are also very troublesome in post-acute rehabilitation in younger patients. The Alderbourne Neuro-rehabilitation Unit treats a younger age group of patients with traumatic brain injury, multiple sclerosis, strokes, and non-traumatic spinal cord injury. The average age in May 2004 was 56. We audit all the incident forms pertaining to falls on the unit and a pattern similar to that observed by Vassallo et al. is emerging.
During the eighteen months January 2003 to June 2004 there were 34 falls recorded among inpatients admitted for rehabilitation. 19 (55%) were isolated incidents but the other 15 were recurrent falls (6 patients with an average of 2.5 falls each). All of these fallers had cognitive impairment. Whilst most of these falls only resulted in minor injury, 2 resulted in trauma sufficient to affect the ability to participate in rehabilitation and increased the length of stay.
Whilst a history of previous falls is a predictor of potential risk of future falls, cognitive impairment is the other predictor that requires highlighting. Low scores on three items of the admission Functional Independence Measure (a standardized outcome measure regularly used on neurological rehabilitation units)—namely, comprehension, memory and safety awareness—coupled with a history of falls, should assist in the risk assessment process for these patients.
Having identified patients at high risk of falls the interventions to prevent further falls that have been reviewed include alert bracelets,2 attention to flooring,3 and corridor lighting, additional exercises as well as a multidisciplinary multiple intervention programme including the use of hip protectors. Vassallo et al. state that the 'arguments for a multifactorial intervention remain weak'. However in a randomized controlled trial Haines et al.4 showed a 30% reduction in falls using a targeted multiple interventions falls prevention programme. Chang et al.5 likewise concluded that such programmes are effective.