HOW TO MANAGE RECURRENT FALLS IN CLINICAL PRACTICE: GUIDELINES OF THE FRENCH SOCIETY OF GERIATRICS AND GERONTOLOGY

Background: Health care professionals need a simple and pragmatic clinical approach for the management of recurrent fallers in clinical routine. Objective: To develop clinical practice recommendations with the aim to assist health care professionals, especially in primary care in the management of recurrent falls. Methods: A systematic English and French review was conducted using Medline, Embase, Pascal and Cochrane literature. Search included systematic reviews, meta-analyses, controlled trials, cohort studies, case-control studies and transversal studies published until July 31, 2008. The following Medical Subject Heading (MeSH) terms were used: aged OR aged, 80 and over, frail elderly, Accidental Fall, Mental Recall, and Recurrent falls. The guidelines were elaborated according the Haute Autorite de Sante methods by a multidisciplinary working group comprising experts and practitioners. Results: A fall is an event that results in a person coming to rest inadvertently on the ground or floor or other lower level and should be considered as a recurrent event as soon as a subject reported at least two falls in a 12-month period. Recurrent falls impose a prompt and appropriate management with the first aim to systematically evaluate the severity of falls. The evaluation of fall severity should be based on a standardized questionnaire and physical examination. It is recommended not to perform cerebral imaging in the absence of specific indication based on the clinical examination and to reevaluate the subject within a week after the fall. Prior to any intervention and after an evaluation of signs of severity, it is recommended to systematically assess the risk factors for falls. This evaluation should be based on the use of validated and standardized tests. The education of recurrent fallers and their care givers is required in order to implement appropriate intervention. In the event of a gait and/or balance disorders, it is recommended to prescribe physiotherapy. A regular physical activity should be performed with low to moderate intensity exercise. It is recommended to perform rehabilitation exercises with a professional, between therapy sessions and after each session, in order to extend rehabilitation benefits to the daily life. Conclusion: The clinical guidelines focused on management (i.e., diagnosis, assessment and treatment) of recurrent falls in clinical routine. They provide answers to the following clinical questions: 1) How to define recurrent falls? 2) How to identify severe falls? 3) How to assess recurrent falls? and 4) How to treat recurrent falls?