Falls in Older People: Risk Factors and Strategies for Prevention.

Lord SR, Sherrington C, Menz HB. New York, NY 10011-4211, Cambridge University Press, 2001, paperback, 258 pp, illus, ISBN: 0-521-58964-9, $49.95.

This book is a concise yet comprehensive review of the most recent research on falls in the elderly. The authors present both supporting and contradictory evidence for common patterns of clinical practice in the assessment, management, and prevention of falls. They analyze both the quality and depth of the literature as well as discuss possible reasons for discrepancies that may exist. In addition, the authors include the results of their own work without bias and with careful consideration for how their research compares with other studies. For these reasons, they have successfully fulfilled their stated purposes of providing a detailed analysis of the most recent developments in this area and helping bridge the gap between scientific journal articles and general texts.

The book covers 3 primary topic areas: risk factors, prevention strategies, and directions for future research. The coverage of risk factors is comprehensive and blends together the findings of numerous studies in a concise, organized, and readable format. The chapters in this area cover the epidemiology of falls and fall-related injuries, postural stability, and the sensory, neuromuscular, medical, medication, and environmental risk factors for falls. This first part of the book is well summarized in tables that provide a strength-of-evidence rating for each of the risk factors.

The second part of the book deals with strategies for prevention, including exercise, environmental modification, footwear, assistive devices, medical management, and medication modification. It also includes chapters on the prevention of falls in hospitals and residential elderly care facilities (long-term care), targeted falls prevention strategies, and a physiological profile approach for falls prevention. This second part of the book is also well substantiated with an extensive review and analysis of the literature. However, it lacks a discussion of physical therapy interventions, restraint reduction and alternatives, and performance-based clinical balance measures for the prediction of falls. None of the physical therapy-related literature is cited to describe or support the effect of an intervention on improving postural control and decreasing fall risk. The emphasis is on a general discussion of the motor learning model of rehabilitation.

The section on restraints is also brief and does not include any information on multidisciplinary interventions as alternatives to restraints. Finally, performance-based clinical balance measures such as the Timed Up & Go Test, Tinetti Performance-Oriented Mobility Assessment, Berg Balance Scale, and Dynamic Gait Index are not mentioned, and their absence is noticeable. The Functional Reach Test is only briefly mentioned.

The second part of the book, however, does have an excellent review of the studies that utilized large randomized clinical trials of multifactorial interventions such as the FICSIT (Frailty and Injuries: Cooperative Studies of Intervention Techniques) trials. It concludes with a description of the authors' proposed physiological profile approach for fails prevention, which was under study at the time of publication. This approach proposes a method for a comprehensive assessment and management program to reduce falls.

The third part of the book deals with directions for future research. It is an organized, methodical summary of the gaps in the current body of evidence surrounding falls in the elderly. It goes beyond a recapitulation of the other chapters and discusses additional concepts that should be considered for future research.

Each chapter is well organized with an introduction, clearly defined subsections, an informative but concise conclusion, and references. Illustrations are effective and used with discretion. When not readily apparent, applications to clinical practice are provided. Some Australian spellings and terminology are used but are easily understood.

This book is essential for every physical therapist who works with the elderly, because the evaluation of fall risk is a critical element of primary and secondary prevention for these patients. It provides the basis for a comprehensive, evidence-based approach to falls risk assessment and prevention. Although physical therapists will need to supplement this book with other sources for research evidence about specific physical therapy interventions, restraints, and performance-based clinical balance measures, this book prepares clinicians to look critically at how they identify and manage patients at risk for falls in light of the current evidence.

Michael J Shoemaker, PT, DPT
Spectrum Health
Grand Rapids, Mich

Dr Shoemaker is Physical Therapist in Rehabilitation and Sports Medicine Services department. His primary area of clinical practice is geriatric subacute care. His current research interests are the prediction of response to rehabilitation in patients with stroke and the use of the Minimum Data Set (MDS 2.0) as an outcome measure for subacute rehabilitation.