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July 3, 1996, Vol 276, No. 1 >
ARTICLE | July 3, 1996

An 85-Year-Old Woman With a History of Falls FREE

Lewis A. Lipsitz, MD
[+] Author Affiliations

This conference took place at the Department of Medicine Morbidity and Mortality Conference of the Beth Israel Hospital, Boston, Mass, on March 26, 1996.

Reprints: Thomas L. Delbanco, MD, Division of General Medicine and Primary Care, Beth Israel Hospital, 330 Brookline Ave, LY310, Boston, MA 02215.

Clinical Crossroads at Boston's Beth Israel Hospital is produced and edited by Thomas L. Delbanco, MD, and Jennifer Daley, MD; Janet Walzer MEd, is managing editor. Clinical Crossroads section editor: Margaret A. Winker, MD, Senior Editor, JAMA.


JAMA. 1996;276(1):59-66. doi:10.1001/jama.1996.03540010061031
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References

Dr Delbanco:  Mrs R is an 85-year-old widowed retired municipal worker who is the mother of 2 sons, one of whom is unmarried and lives with her in an urban community near Boston, Mass. Born in Italy, Mrs R came to the United States as a teenager and worked until retiring 10 years ago because of progressive arthritic pain and accompanying unsteadiness. She has no income other than Social Security, receives Medicare, and is eligible for lifesaving free medications at the Beth Israel Hospital, where she has been cared for by a general internist, Dr B, for more than 20 years. In recent years her medical problems have focused on difficulty walking and several falls and near falls, resulting in her being virtually homebound. She lives on the first floor of a house with a few steep steps outside the entrance, which limit her ability to move in and out

REFERENCES

1 +
Kiel DP, O'Sullivan P, Teno JM, Mor V.  Health care utilization and functional status in the aged following a fall . Med Care . 1991;;29:221-228.
2 +
King MB, Tinetti ME.  Falls in community-dwelling older persons . J Am Geriatr Soc . 1995;;43:1146-1154.
3 +
Tinetti ME, Liu WL, Claus EB.  Predictors and prognosis of inability to get up after falls among elderly persons . JAMA . 1993;;269:65-70.
4 +
Tinetti ME, Mendes de Leon CF, Doucette JT, Baker DI.  Fear of falling and fall-related efficacy in relationship to functioning among community-living elders . J Gerontol . 1994;;49:M140-M147.
5 +
Nevitt MC, Cummings SR, Kidd S, Black D.  Risk factors for recurrent nonsyncopal falls: a prospective study . JAMA . 1989;;261:2663-2668.
6 +
Lipsitz LA, Jonsson PV, Kelley MM, Koestner JS.  Causes and correlates of recurrent falls in ambulatory frail elderly . J Gerontol . 1991;;46:M114-M122.
7 +
Lipsitz L, Wei JY, Rowe JW.  Syncope in an elderly, institutionalized population: prevalence, incidence, and associated risk . Q J Med . 1985;;55:45-54.
8 +
Alexander NB.  Postural control in older adults . J Am Geriatr Soc . 1994;;42:93-108.
9 +
Wolfson L.  Falls and gait . In: Katzman R, Rowe JW, eds. Principles of Geriatric Neurology . Philadelphia, Pa: FA Davis Co Publishers; 1992;:281-299.
10 +
Woollacott MH.  Changes in posture and voluntary control in the elderly: research findings and rehabilitation . In: Lewis CB, Woollacott MH, eds. Topics in Geriatric Rehabilitation . Gaithersburg, Md: Aspen Publishers Inc; 1990;:1-11.
11 +
Lipsitz LA.  Abnormalities in blood pressure homeostasis that contribute to falls in the elderly . Clin Geriatr Med . 1985;;1:637-648.
12 +
Jonsson PV, Lipsitz LA, Kelley MM, Koestner JS.  Hypotensive responses to common daily activities in institutionalized elderly: a potential risk for recurrent falls . Arch Intern Med . 1990;;150:1518-1524.
13 +
Phillips PA, Phil D, Rolls BJ, et al.  Reduced thirst after water deprivation in healthy elderly men . N Engl J Med . 1984;;311:753-759.
14 +
Tinetti ME, Speechley M, Ginter SF.  Risk factors for falls among elderly persons living in the community . N Engl J Med . 1988;;319:1701-1707.
15 +
Campbell AJ, Borrie MJ, Spears GF.  Risk factors for falls in a communitybased prospective study of people 70 years and older . J Gerontol . 1989;;44:M112-M117.
16 +
Robbins AS, Rubenstein LZ, Josephson KR, Schulman BL, Osterweil D, Fine G.  Predictors of falls among elderly people: results of two populationbased studies . Arch Intern Med . 1989;;149:1628-1633.
17 +
Tinetti ME, Williams TF, Mayewski R.  Fall risk index for elderly patients based on number of chronic disabilities . Am J Med . 1986;;80:429-434.
18 +
Drachman DA, Hart CW.  An approach to the dizzy patient . Neurology . 1972;;22:323-334.
19 +
Lipsitz LA.  Orthostatic hypotension in the elderly . N Engl J Med . 1989;;321:952-957.
20 +
Jansen RWMM, Connelly CM, Kelley-Gagnon MM, Parker JA, Lipsitz LA.  Postprandial hypotension in elderly patients with unexplained syncope . Arch Intern Med . 1995;;155:945-952.
21 +
Sudarsky L, Ronthal M.  Gait disorders among elderly patients: a survey study of 50 patients . Arch Neurol . 1983;;40:740-743.
22 +
Meissner I, Wiebers DO, Swanson JW, O'Fallon WM.  The natural history of drop attacks . Neurology . 1986;;36:1029-1034.
23 +
Archea JC.  Environmental factors associated with stair accidents by the elderly . Clin Geriatr Med . 1985;;1:555-569.
24 +
Podsiadlo D, Richardson S.  The timed 'up & go': a test of basic functional mobility for frail elderly persons . J Am Geriatr Soc . 1991;;39:142-148.
25 +
Munro NC, McIntosh S, Lawson J, Morley CA, Sutton R, Kenny RA.  Incidence of complications after carotid sinus massage in older patients with syncope . J Am Geriatr Soc . 1994;;42:1248-1251.
26 +
Fiatarone MA, O'Neill EF, Doyle N, et al.  Exercise training and nutritional supplementation for physical frailty in very elderly people . N Engl J Med . 1994;;330:1769-1775.
27 +
Tinetti ME, Baker DI, McAvay G, et al.  A multifactorial intervention to reduce the risk of falling among elderly people living in the community . N Engl J Med . 1994;;331:821-827.
28 +
Wagner EH, LaCroix AZ, Grothaus L, et al.  Preventing disability and falls in older adults: a population-based randomized trial . Am J Public Health . 1994;;84:1800-1806.
29 +
Province MA, Hadley EC, Hornbrook MC, et al, for the FICSIT Group.  The effects of exercise on falls in elderly patients: a preplanned meta-analysis of the FICSIT trials . JAMA . 1995;;273:1341-1347.
30 +
Wolf SL, Barnhart HX, Kutner NG, et al for the Atlanta FICSIT Group.  Reducing frailty and falls in older persons: an investigation of tai chi and computerized balance training . J Am Geriatr Soc . 1996;;44:489-497.
31 +
Lauritzen JB, Petersen MM, Lund B.  Effect of external hip protectors on hip fractures . Lancet . 1993;;341:11-13.

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1 +
Kiel DP, O'Sullivan P, Teno JM, Mor V.  Health care utilization and functional status in the aged following a fall . Med Care . 1991;;29:221-228.
2 +
King MB, Tinetti ME.  Falls in community-dwelling older persons . J Am Geriatr Soc . 1995;;43:1146-1154.
3 +
Tinetti ME, Liu WL, Claus EB.  Predictors and prognosis of inability to get up after falls among elderly persons . JAMA . 1993;;269:65-70.
4 +
Tinetti ME, Mendes de Leon CF, Doucette JT, Baker DI.  Fear of falling and fall-related efficacy in relationship to functioning among community-living elders . J Gerontol . 1994;;49:M140-M147.
5 +
Nevitt MC, Cummings SR, Kidd S, Black D.  Risk factors for recurrent nonsyncopal falls: a prospective study . JAMA . 1989;;261:2663-2668.
6 +
Lipsitz LA, Jonsson PV, Kelley MM, Koestner JS.  Causes and correlates of recurrent falls in ambulatory frail elderly . J Gerontol . 1991;;46:M114-M122.
7 +
Lipsitz L, Wei JY, Rowe JW.  Syncope in an elderly, institutionalized population: prevalence, incidence, and associated risk . Q J Med . 1985;;55:45-54.
8 +
Alexander NB.  Postural control in older adults . J Am Geriatr Soc . 1994;;42:93-108.
9 +
Wolfson L.  Falls and gait . In: Katzman R, Rowe JW, eds. Principles of Geriatric Neurology . Philadelphia, Pa: FA Davis Co Publishers; 1992;:281-299.
10 +
Woollacott MH.  Changes in posture and voluntary control in the elderly: research findings and rehabilitation . In: Lewis CB, Woollacott MH, eds. Topics in Geriatric Rehabilitation . Gaithersburg, Md: Aspen Publishers Inc; 1990;:1-11.
11 +
Lipsitz LA.  Abnormalities in blood pressure homeostasis that contribute to falls in the elderly . Clin Geriatr Med . 1985;;1:637-648.
12 +
Jonsson PV, Lipsitz LA, Kelley MM, Koestner JS.  Hypotensive responses to common daily activities in institutionalized elderly: a potential risk for recurrent falls . Arch Intern Med . 1990;;150:1518-1524.
13 +
Phillips PA, Phil D, Rolls BJ, et al.  Reduced thirst after water deprivation in healthy elderly men . N Engl J Med . 1984;;311:753-759.
14 +
Tinetti ME, Speechley M, Ginter SF.  Risk factors for falls among elderly persons living in the community . N Engl J Med . 1988;;319:1701-1707.
15 +
Campbell AJ, Borrie MJ, Spears GF.  Risk factors for falls in a communitybased prospective study of people 70 years and older . J Gerontol . 1989;;44:M112-M117.
16 +
Robbins AS, Rubenstein LZ, Josephson KR, Schulman BL, Osterweil D, Fine G.  Predictors of falls among elderly people: results of two populationbased studies . Arch Intern Med . 1989;;149:1628-1633.
17 +
Tinetti ME, Williams TF, Mayewski R.  Fall risk index for elderly patients based on number of chronic disabilities . Am J Med . 1986;;80:429-434.
18 +
Drachman DA, Hart CW.  An approach to the dizzy patient . Neurology . 1972;;22:323-334.
19 +
Lipsitz LA.  Orthostatic hypotension in the elderly . N Engl J Med . 1989;;321:952-957.
20 +
Jansen RWMM, Connelly CM, Kelley-Gagnon MM, Parker JA, Lipsitz LA.  Postprandial hypotension in elderly patients with unexplained syncope . Arch Intern Med . 1995;;155:945-952.
21 +
Sudarsky L, Ronthal M.  Gait disorders among elderly patients: a survey study of 50 patients . Arch Neurol . 1983;;40:740-743.
22 +
Meissner I, Wiebers DO, Swanson JW, O'Fallon WM.  The natural history of drop attacks . Neurology . 1986;;36:1029-1034.
23 +
Archea JC.  Environmental factors associated with stair accidents by the elderly . Clin Geriatr Med . 1985;;1:555-569.
24 +
Podsiadlo D, Richardson S.  The timed 'up & go': a test of basic functional mobility for frail elderly persons . J Am Geriatr Soc . 1991;;39:142-148.
25 +
Munro NC, McIntosh S, Lawson J, Morley CA, Sutton R, Kenny RA.  Incidence of complications after carotid sinus massage in older patients with syncope . J Am Geriatr Soc . 1994;;42:1248-1251.
26 +
Fiatarone MA, O'Neill EF, Doyle N, et al.  Exercise training and nutritional supplementation for physical frailty in very elderly people . N Engl J Med . 1994;;330:1769-1775.
27 +
Tinetti ME, Baker DI, McAvay G, et al.  A multifactorial intervention to reduce the risk of falling among elderly people living in the community . N Engl J Med . 1994;;331:821-827.
28 +
Wagner EH, LaCroix AZ, Grothaus L, et al.  Preventing disability and falls in older adults: a population-based randomized trial . Am J Public Health . 1994;;84:1800-1806.
29 +
Province MA, Hadley EC, Hornbrook MC, et al, for the FICSIT Group.  The effects of exercise on falls in elderly patients: a preplanned meta-analysis of the FICSIT trials . JAMA . 1995;;273:1341-1347.
30 +
Wolf SL, Barnhart HX, Kutner NG, et al for the Atlanta FICSIT Group.  Reducing frailty and falls in older persons: an investigation of tai chi and computerized balance training . J Am Geriatr Soc . 1996;;44:489-497.
31 +
Lauritzen JB, Petersen MM, Lund B.  Effect of external hip protectors on hip fractures . Lancet . 1993;;341:11-13.

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