Falls Prevention

September 7, 2011

A fall is defined as an unplanned descent to the ground with or without injury. Risk factors for falls are described as intrinsic (having to do with an individual’s condition and symptoms, or internal characteristics of the individual) or extrinsic (having to do with the environment, or characteristics that are external to the individual).

Examples of intrinsic risk factors are heart problems and sleep disturbances, postmeal blood pressure changes, neurological and muscle disease, urinary or bowel incontinence, dementia or mental confusion, and impulsivity. Examples of extrinsic risk factors include icy sidewalks, throw rugs, or poor footwear. Falls can happen to anyone anytime. Older women, especially Caucasian and Asian women, are at higher risk. Falls are the leading cause of death in people over age 75. Most falls occur in the home, and many occur either in the bathroom or when getting up to go to the toilet. Hip fractures are the most severe consequence of a fall, and 75% of people who suffer a hip fracture never recover completely. Half of all patients who suffer a fall causing serious injury will die within 1 year.

Older people are at higher risk of falling because the natural process of aging reduces eyesight, balance, and proprioception (the inner sense of the body’s position in space). Osteoporosis is a major risk factor for falls among middleto late-aged women, because it can affect strength, balance, and postural stability. Injury due to falls and the fear of repeat falls can cause elderly people to avoid physical activity, leading to reduced strength and deconditioning, putting them at even greater risk for falls. A history of previous falls, especially within the last 3 months, is among the strongest predictors of repeat falls.

Simple changes can reduce the risk of falls in the household, such as removing clutter, tripping hazards, and slippery surfaces. Throw rugs and electrical cords running across the floor should be eliminated. Carpet edges should be tacked or taped down. Bathrooms should have sturdy grab rails near the tub and toilet (towel rods are not strong enough). Elevated toilet seats can make it easier to sit and stand up again. In some cases, a bedside commode may be necessary to reduce the need to walk any distance or climb stairs at night. Lighting should be bright and easily accessible in all rooms of the house. Stairs should have handrails on both sides. Footwear should be practical, with nonskid soles and adequate support. Nighttime footwear should be nonskid, fit snugly, and not fall off. Alcohol intake should be minimized or avoided completely.

If assistive devices such as canes or walkers are needed, they should be used consistently. In the case of falls, false pride and unwillingness to use appropriate equipment can lead to life-threatening injury. Scheduled toileting can help avoid the urgent need to urinate and reduce the risk of falls. Drinking adequate fluids will help avoid lowered blood pressure from mild dehydration. People who become dizzy when arising from bed should sit on the bed for 1-2 minutes before walking. Balancing and strengthening exercises such as water exercise, tai chi, or yoga can reduce the risk of falls. If physical conditions such as urinary urgency or dizziness are a persistent problem, medical treatment may be helpful.

Some medications can increase the risk of falls. Sedating medications can cause grogginess. Blood pressure medications can cause dizziness. Appropriate use of these medications can minimize the risk of falls. Elderly people should ask their physician to review their medications with the risk of falling in mind. If an elderly person falls twice within 6 months, even without significant injury, a medical evaluation should be done to look for treatable causes.

SEE ALSO: Osteoporosis and osteopenia

Category: F