Current opinion in neurology vol:16 issue:1 pages:15-26
PURPOSE OF REVIEW: Falls among elderly persons create immense social problems because of their association with physical decline, serious psychosocial consequences, negative impact on the quality of life, and markedly reduced survival. In addition, falls pose high costs to the public health service. For these reasons, falls remain a popular topic for research. Here, we review several interesting developments that have been published during the past year. RECENT FINDINGS: Considerable attention has been focused on early identification of fallers and prevention strategies for falls or injuries. A remaining challenge is to implement such strategies into daily clinical practice, at acceptable costs and with good acceptance. New evidence has been generated to suggest the importance of high-level processing for postural control, but it remains difficult to predict falls based upon a simple dual tasking test. Neuroimaging studies are now beginning to provide new insights into the role of cortical structures in balance regulation, and how cortical dysfunction might contribute to falls. Posturography studies using multidirectional moving platforms or computer models of balance have provided new insights into falling mechanisms, in particular the role of abnormal protective responses (stepping or grasping) and the negative effects of stiffening. Other studies have shown how a fear of falling, a common sequel to falls, may lead to secondary degeneration of postural control, thus completing a vicious loop. SUMMARY: While these examples illustrate that falls research is very much ongoing, one cannot speak of true progress until the scientific evidence can be implemented into real life, with falls being prevented effectively in individual cases.