title: Instability in the older adult.
abstract: Instability and falling are common concerns for older adults and their clinical providers as well as contributors to the epidemic consequences of hip fracture and other traumatic injuries from falls. Thoughtful attention to the historic description of the symptoms, consideration of the underlying medical conditions, and a critical review of the medication list should be combined with a careful physical examination and selected tests of physical function. A recent onset of symptoms may warrant diagnostic testing to rule out acute reversible pathology. In those with chronic instability, testing should be carried out selectively when indications from the history and physical examination point to a specific need. The etiology of chronic instability in older adults is generally multifactorial; as a result, therapy requires an attempt at improvement in any impairments that are amenable to treatment combined with adaptation to those that are fixed wherever possible. Finally, the restoration of a patient's confidence in their ability to safely carry out desired activities is critical to guard against a downward spiral of fear, restriction of activity, further deconditioning, and worsening instability.
authors.affiliation: Ambulatory Care Veterans Affairs Medical Center, Kansas City, Missouri 64128, USA.
authors.forename: S K
authors.initials: SK
authors.lastname: Rigler
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D004244:Dizziness / Q000150:complications; D006801:Humans; D009460:Neurologic Examination; D010348:Patient Care Team; D004856:Postural Balance