Risk of Falls: Practice parameter: Assessing patients in a neurology practice fo

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Neurology. 2008 Feb 5;70(6):473-9.

Practice parameter: Assessing patients in a neurology practice for

risk of falls (an evidence-based review): report of the Quality

Standards Subcommittee of the American Academy of Neurology.

Thurman DJ, s JA, Rao JK; Quality Standards Subcommittee of the

American Academy of Neurology.

National Center for Chronic Disease Prevention and Health Promotion,

Centers for Disease Control and Prevention, Atlanta, GA, USA.

OBJECTIVE: To develop a practice parameter for screening methods and

assessments of risk for falls pertaining to patients likely to be

seen in neurology practices.

METHODS: Relevant literature was systematically reviewed and strength

of evidence classified based on the American Academy of Neurology's

criteria (Level A: established; Level B: probable; Level C:

possible).

RESULTS: An increased risk of falls is established among persons with

diagnoses of stroke, dementia, and disorders of gait and balance

(Level A) and probable among patients with Parkinson disease,

peripheral neuropathy, lower extremity weakness or sensory loss, and

substantial vision loss (Level . A history of falling in the past

year strongly predicts the likelihood of future falls (Level A).

Screening measures have been developed to further assess risks of

falls, including functional assessments that may be useful (Levels B

and C). Several of these assess overlapping neurologic functions--

i.e., gait, mobility, and balance--and there is insufficient evidence

to assess whether they offer benefit beyond that provided by a

standard neurologic examination.

CONCLUSIONS: Patients with neurologic or general conditions

associated with an increased risk of falling should be asked about

recent falls and further examined for the presence of specific

neurologic deficits that predict falls, which include gait and

balance disorders; deficits of lower extremity strength, sensation,

and coordination; and cognitive impairments. If substantial risks of

falls are identified, appropriate interventions that are described in

other evidence-based guidelines may be considered.