The American Geriatrics Society and the British Geriatric Society have issued updated guidelines for preventing falls in older people. It is the first such update in over 10 years.

“There is always evidence that is coming out and in area like falling, we are learning more about it every day,” says Mary Tinetti, MD, a professor of medicine at Yale University School of Medicine, New Have, Ct., and a co-chair of the panel that came up with the guidelines. “We want to make sure the guidelines are as timely and accurate as possible.”

While the guidelines, which appear in the January 2011 issue of the Journal of the American Geriatrics Society, target older patients, they apply to patients of any age with rheumatic disease involving gait.

“It relates to all of our patients who have lower extremity disorders,” says Nortin M. Hadler, MD, attending rheumatologist at UNC Hospitals and professor of medicine and microbiology/immunology at University of North Carolina at Chapel Hill.

“Gait is quite remarkable. It’s a highly integrated biological function that requires heel strike and push off of toes, knees that are supple and hips with reasonable range of motion,” says Dr. Hadler. “All of these things we take for granted, but if anyone has any impairment, they don’t take it for granted.” Dr. Hadler notes that patients with rheumatic disease also fall “less well” because they are less able to brace themselves when they do fall.

The new guidelines call for a complete risk assessment for patients who simply report difficulties with gait or balance in addition to those who have a history of falling. The assessment should include evaluation for muscle weakness, balance problems, orthostatic hypotension (a fall in blood pressure when a person stands up from a sitting or lying down position), as well as an examination of the feet and footwear, and an evaluation of both daily living skills and the use of adaptive equipment and mobility aids. Health care professionals should also ask patients about the fear of falling.

“Falls are a very serious problem and they often have a complex set of causes that can be a challenge to sort out. One of those things is that we are fearful,” says Sharon Brangman, MD, president of the American Geriatric Society. “Patients can be so fearful that it limits mobility, which sets up a vicious cycle: We are fearful, so we restrict our activities, and our muscles get weaker and so we are more likely to fall.”