Falls in Older Adults

Falls are the leading cause of fatal and nonfatal injuries in older adults.[i] More than one in four older adults fall every year and less than half will tell their doctor.[ii] Nearly 1 out of 5 falls cause a serious injury such as a broken bone or a head injury.[iii] Many older adults who fall even if they are not injured develop a fear of falling and reduce their activity which in turn increases their risk for falling. Falls can lead to a loss of independence and ability to perform everyday activities. With more than 10,000 Americans turning 65 each day, falls are a growing and significant public health problem.


So, one may ask, why do people fall?

 A “Fall” is defined when a person accidentally comes to rest on the ground or at a lower level or essentially the inability to stay upright.

Any challenge to our ability to be upright can lead to a fall.  There are several risk factors that can lead to a fall These are divided into individual (intrinsic) factors, environmental factors and acute or trigger factors.

Individual Factors Environmental Factors
Trigger/Acute Factors
  • Lower body weakness
  • Difficulties with walking or balance
  • Vision problems
  • High risk medications
  • Feet/footwear problems
  • Lightheadedness with change in position
  • Memory problems
  • Joint problems
  • Decreased endurance
  • Throw Rugs
  • Loose cords
  • Poor lighting
  • Pets
  • Uneven stairs
  • Cracked sidewalks
  • Slippery surfaces
  • Low or unstable furniture
  • Clutter
  • Lower body weakness
  • Difficulties with walking or balance
  • Vision problems
  • High risk medications
  • Acute illness (e.g. urinary tract infection, pneumonia)
  • Dehydration
  • Low blood pressure
  • Low blood sugars
  • Blood loss
  • Low oxygen

 


What do we do to reduce falls?

Falls are more common in older adults, but they are not an inevitable part of normal aging. They are preventable by taking a few simple steps to reduce your risk and stay independent longer.


1) Be proactive 
        • Ask your healthcare provider to assess your fall risk and create an individualized fall prevention plan
        • Assess your risk by using Stay independent screening test developed
          by the CDC
        • Tell your provider if you have a fall 


2) Have your provider or pharmacist perform a medication review

Since four out of every five older adults take at least one prescription medication daily, and more than one third take five or more each day, this common risk factor for falling demands attention. Medications are one of the most common risk factors for increased falls - and they are also a relatively easy modifiable factor. A few medications that can impact falls in older adults include: 

        • Certain medications called psychotropic medications which include medications for sleeping, anti-anxiety and restless dementia behaviors can increase fall risk
        • Anticholinergic medications- which can affect balance and thinking. These include over the counter “pm” meds, anti-allergy meds and medications used for overactive bladder
        • Opiates especially when new
        • Diuretic (water pills) medications
        • Blood pressure/blood sugar medications


3) Be active
        • Exercise regularly
        • Exercise should include strength and balance exercises example Tai Chi
        • May involve referral to a special exercise program or Physical therapy

Use an assistive device that has been recommended for you by your healthcare provider or therapist and that has been fitted for you. Using a device inappropriately or not sized for you can cause more harm than good.


4) Regular eye check ups

        • Have your eyes checked by an eye doctor at least once a year, and correct glasses as needed.
        • If you have bifocal or progressive lenses, you may want to get a pair of glasses with only your distance prescription for outdoor activities, such as walking. Sometimes these types of lenses can make things seem closer or farther away than they really are.


5) Assessment of feet and footwear

        • Regular foot assessment and foot care
        • Shoes with firm nonskid soles and low heels
        • Avoid footies or slippers  


6) Assess home safety

 

Blog Contributor:   


Josephine Gomes, MD
Assistant Professor of Geriatric Medicine
University of Louisville
[email protected]



[i] https://www.ncoa.org/news/resources-for-reporters/get-the-facts/falls-prevention-facts/

[ii]Bergen G, Stevens MR, Burns ER. Falls and Fall Injuries Among Adults Aged ≥65 Years — United States, 2014. MMWR Morb Mortal Wkly Rep 2016;65:993–998. DOI: http://dx.doi.org/10.15585/mmwr.mm6537a2; Stevens JA, Ballesteros MF, Mack KA, Rudd RA, DeCaro E, Adler G. Gender differences in seeking care for falls in the aged Medicare Population. Am J Prev Med 2012;43:59–62.

[iii] Alexander BH, Rivara FP, Wolf ME. The cost and frequency of hospitalization for fall–related injuries in older adults. American Journal of Public Health 1992;82(7):1020–3; Sterling DA, O’Connor JA, Bonadies J. Geriatric falls: injury severity is high and disproportionate to mechanism. Journal of Trauma–Injury, Infection and Critical Care 2001;50(1):116–9

 

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