Expert Commentary

* Falls and Physical Stress: Effects of Long-Term Living in Evacuation Settings

David Thomas, MD

Associate Clinical Professor
Mt. Sinai School of Medicine
New York, NY

The risk of falls and associated injuries pose serious problems for elderly patients, especially when displaced elderly are living in disrupted environments in the aftermath of a large-scale disaster. Non-syncopal falls are common in such settings and, in addition to possible physical injury, often leave the patient fearful of further ambulation. Falls tend be associated with either predisposing factors or situational factors. Common predisposing factors include problems with visual acuity, cardiovascular pathologies, postural hypertension, prior stroke, neurological insult which renders the patient less able to adapt to the surroundings, musculoskeletal deficits, severe arthritis, simultaneous use of four or more medications and alcoholism. Any indications of cognitive impairments such as dementia should also be assessed. Among the situational factors regularly encountered after a disaster such as the Tohoku earthquake and tsunami are residency in a novel and unfamiliar environment, encountering unexpected debris, carrying heavy objects, conducting increased levels of physical activity, encountering slippery areas, poorly-fitting shoes due to loss of personal clothing, and dim or inappropriate lighting. There are several well-defined assessments the informed clinician can make to minimize the danger. Chief among these would be taking a thorough history to identify predisposing factors. This would be followed by determining what conditions are like where the patient is living, accompanied by queries as to whether or not the patient requires any ambulatory aids on a daily basis. Finally, a good physical exam is required - with a particular focus on the musculoskeletal patency of the lower extremities and identifying any carotid bruits. As a last step the clinician might administer a simple get-up-and-go test where the patient is required to rise from a chair or tatami, walk about 10 steps and then return. As a general rule, patients who might be somewhat compromised in terms of balance should consider tai-chi for self-therapy.


  1. Soriano TA et al (2007) Falls in the community-dwelling older adult: a review for primary-care providers. Clin Interv Aging. 2007;2(4):545-54.
  2. Mayhew PM, et al (2005) Relation between age, femoral neck cortical stability, and hip fracture risk. Lancet. Jul 9-15;366(9480):129-35.
  3. Gates S, et al (2008) Multifactorial assessment and targeted intervention for preventing falls and injuries among older people in community and emergency care settings: systematic review and meta-analysis. BMJ. Jan 19;336(7636):130-3


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