Family Practice Vol. 18, No. 4, 470
© Oxford University Press 2001
Book review |
Falls in older people: risk factors and strategies for prevention.
Stephen Lord, Catherine Sherrington, Hylton B Menz. [258 pages, £29.95 (US$ 49.95).] Cambridge University Press, 2000. ISBN 0-521-58964-9.
Professor of Clinical Geratology, University of Oxford
The importance of falling as a source of morbidity, mortality and misery for old people has been recognized for over 50 years since the pioneering work of Sheldon. The volume of research work has grown enormously since the 1970s, but it has been disjointed and repetitive as well as of variable quality. The first 115 pages of this book are devoted to a valuable extended review of the research on risk factors for falls by older people. It is scholarly, with the number of references per chapter ranging up to 222 in the case of medical risk factors. The text style is easy, however, so no one should be put off. The final chapter in this section is a summary of the field with an appraisal of the strength of evidence for each factor. There is then a short summary of risk factors identifying those that are potentially modifiable with their corresponding intervention strategies. Chapters follow on exercise, environmental modifications, footwear, assistive devices and integrative approaches to the prevention of falls in hospitals and residential facilities. A chapter on the medical management of older people at risk of falls focuses, as is most appropriate, on the primary care setting. Advice on modification of medication as a means of reducing risk of falls is addressed to patients (and carers) as well as health professionals. Targeted programmes are reviewed, with their NNT (number needed to treat) values duly listed. The penultimate chapter presents a scheme of physiological profiling, as a means of assessing and modifying individual risk.
This is an excellent book, readable as a whole but with self-contained chapters suitable as source material for any health care professional with responsibilities for older people. There is therefore some repetition (including two presentations of the same full-page figure in different chapters), but there is no harm in repeating the important, and the whole book is aimed at sorting out what matters from the merely intriguing. This is evidence-based medicine at its most relevant.
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