Why are falls in the elderly an important topic? To answer this question, consider these quick facts:
- Many falls are not a normal part of aging, but are the result of many factors.
- The risk of having a fall increases with age, tripling from age 70 to age 90, and is greater for women than men.
- A fall may indicate that an acute illness is present, such as a urinary tract infection, or pneumonia.
- Of those who experience a fall, 2 of 3 people will fall again within 6 months.
- Approximately 50% of injuries from falls result from being unable to rise, such as when a person has pneumonia, is dehydrated, has pressure sores, or has muscle breakdown.
- Hazards in the home are involved in about one-third of elderly falls.
- After a hip fracture, 1 in 4 will die within 6 months; 1 in 4 will require nursing care for the remainder of their life.
- A substantial fiscal burden is attributable to health care for those who have fallen, so it is very important to prevent falls.
- The single best predictor of whether a person will fall is a balance and gait assessment.
- Prior falls or fear of falling can result in a person having reduced mobility, activity-avoidance, depression, anxiety, and/or isolation.
Causes and Prevention
Osteoporosis. Bone density decrease is a factor contributing to falls and the injuries that result from falls; brittle bones may break after a fall or cause a fall after a stress-induced fracture. Get sufficient calcium—1200 to 1500 mg daily for postmenopausal women. Get sufficient vitamin D—400-1000 IU per day. The climate in northern states means fewer sunlight hours, and often more time indoors because of cooler temperatures. Address hormonal imbalances, as appropriate. Talk with your doctor.
Lack of physical activity. Lack of participation in regular exercise leads to poor muscle tone, loss of muscle strength, loss of bone flexibility, and loss of bone mass. Regularly participate in supervised weight-bearing exercises, and exercises to improve balance. Work for a goal of at least 15 minutes daily. Supervised walking and swimming are recommended.
Practice safe reaching and bending; pause after rising from a chair or bed; practice getting up from the floor. Wear shoes that are supportive, fit well, and have low heels or no heels, and rubber soles.
Impaired vision. Vision changes due to age or disease may result in changes in depth perception, acuity or peripheral vision, or cause glare. Vision changes increase the risk of falling. Clean eyeglasses regularly. Have regular checkups by an eye specialist (ophthalmologist or optometrist) to discern the extent of age-related or condition-related eye diseases such as cataracts, glaucoma, macular degeneration or diabetic retinopathy.
Medications. More medications means a greater risk of falling. Certain medications double the risk of a fall—such as drugs that cause sedation, anti-depressants, and narcotic pain relievers. Other common culprits include blood pressure medications, heart medications, drugs that can cause low blood sugar, medications for Parkinson’s disease, and eye medications. Know the side effects of all the medications you take. For each drug you take, use the lowest effective dose of each drug and ask your doctor to reassess each medication yearly. Find out which medications can affect balance or might require the use of a walking aid, such as a cane. Properly discard expired or unused medications. Bring all your medicines to your doctor’s appointments for review.
Alcohol carries its own risks for falls. It also does not mix well with medications and should be limited or avoided altogether.
Environmental hazards. Do a home safety checklist. If you need help, contact social services, your county’s office on aging, or talk to your doctor. Here are some checklists:
- Outside: Fix cracks and depressions in walkways; install handrails; remove clutter; remove snow and ice; install adequate lighting.
- Living spaces: Put hazard tape on stairs; eliminate throw-rugs; have a cordless phone on each level of the home; have sufficient outlets; eliminate clutter; use nightlights; use different colors for furniture, carpet, walls; ensure there is sufficient space between furniture; take wheels off the furniture; lock the wheels of movable equipment; always have a telephone within reach; set the bed at an appropriate height; use a solid chair for dressing.
- Bathroom: Install grab bars; use non-skid mats and rugs; install a hand-held shower; use a raised toilet seat.
- Kitchen: Keep often-used items within reach; use a sturdy step stool with hand support; ensure that cords are safely placed; do not use floor wax.
- Walkways/stairways: No clutter!; use handrails; have good lighting; get rid of loose carpeting or treads on the stairs; use reflective strips on grabs bars, stairs, or areas where the ground level changes, such as on curbs or near mailboxes.
Medical conditions and/or physical impairment. Chronic illnesses, for example, diabetes, arthritis, blood pressure problems, heart rhythm problems, and foot conditions can contribute to falls. Your doctor can help you identify your personal risk for falls. You may need lab tests. Your doctor might also recommend physical therapy or occupational therapy to improve your safety. You might need a wheelchair, walker, or cane. If you drive, ask your doctor if a handicap permit is appropriate for you.
Injury Prevention. For some patients, knee pads, shin pads, elbow pads or ankle pads may be of benefit. There is no convincing research that shows hip protectors are beneficial. Fall alert systems or call-in systems can reduce the length of time that you or your loved one is on the floor after a fall. Talk with your doctor about how you can prevent falls for you and your loved ones.
- Schneider DC and Mader SL. Major syndromes in the elderly: falls. Materials obtained from Aurora-Sinai Geriatrics Clinic, Milwaukee, Wisconsin
© Trinity Integrative Family Medicine, Inc., glkocourek, latest revision 09-May-2021