How to identify balance disorders and reduce fall risk

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doi:doi: 10.12788/jfp.0332

Applied Evidence

How to identify balance disorders and reduce fall risk

J Fam Pract. 2022 January;71(1):20-30 | doi: 10.12788/jfp.0332

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References

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In the emergency department and academic hospitals, key investigations can identify causes of imbalance:

Electrocardiography and Holter monitoring test for cardiac arrhythmias.
Echocardiography identifies structural abnormalities.
Radiography and computed tomography are useful for detecting musculoskeletal abnormalities.
Bone densitometry can identify osteoporosis.
Head and spinal cord magnetic resonance imaging can be used to identify lesions of the central nervous system.
Computed tomographic angiography of the head and neck is useful for identifying stroke, cerebral atrophy, and stenotic lesions of the carotid and vertebral arteries.
Nerve conduction studies and levels of serum vitamin B₁₂, hemoglobin A1C, thyroid-stimulating hormone, and random cortisol can uncover causes of peripheral neuropathy.
Bedside cognitive screening tests can be used to measure cognitive decline.⁷²
Suspicion of vestibular disease requires audiometry and vestibular testing, including videonystagmography, head impulse testing, and vestibular evoked myogenic potentials.

In many cases of imbalance, no specific underlying correctable cause is discovered.

Management of imbalance

Pharmacotherapy

Targeted pharmacotherapy can be utilized in select clinical scenarios:

Medical treatment of peripheral neuropathy should target the underlying condition.
Cognitive behavioral therapy and antidepressants are useful for treating anxiety and depressive disorders.⁷³
Musculoskeletal pain can be managed with acetaminophen and topical nonsteroidal anti-inflammatory drugs (NSAIDs), using a short course of an oral NSAID when needed.⁷⁴
Cardiovascular disease management might include any of several classes of pharmacotherapy, including antiplatelet and lipid-lowering medications, antiarrhythmic drugs, and antihypertensive agents.
Acute episodes of vertigo due to vestibular neuritis or labyrinthitis can be managed with an antiemetic.⁴⁶

Surgical treatment

Surgery is infrequently considered for patients with imbalance. Examples of indications include microsurgical resection of vestibular schwannoma, resection of central nervous system tumors, lens replacement surgery for cataract, surgical management of severe spinal fracture, and hip or knee arthroplasty in select patients.

Tools for assessing the risk of falls

Scoring systems called falls risk assessment tools, or FRAT, have been developed to gauge a patient’s risk of falling. The various FRATs differ in specificity and sensitivity for predicting the risk of falls, and are typically designed for specific clinical environments, such as hospital inpatient care or long-term care facilities. Specifically, FRATs attempt to classify risk using sets of risk factors known to be associated with falls.

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