PREVENTION OF FALLS IN ELDERLY

Falls are one of the common geriatric problems threatening the independence of older people. Between 30 to 40 percent of adults older than 65 years fall each year. Falls are associated with increased morbidity and mortality. Most of the falls have multiple causes as listed below

Falls are common in old age, above 65 years. People in this age group, when they fall, suffer from:

  1. 22-60%- suffer injuries
  2. 10-15 % suffers serious injuries
  3. 2-6 % suffers fractures
  4. 0.2-5% suffer hip fractures

Risk factors for falls:

  • Aging- falls increase with age and fragility of an individual
  • Gender- men tend to have fatal injuries during a fall than a women
  • Medications-medications such as diuretics, beta blockers, nitrates, antidepressants, antihistamines causes orthostatic hypotension leading to falls
  • Polypharmacy- taking four or more medications at once has drug-drug interactions and adverse reactions leading to falls
  • Alcohol abuse- alcohol abuse is one of the major risk factors for falls in all age groups
  • Diabetes- it can be one of the predisposing factor which leads to balance impairments, motor weakness and lower extremity weakness which causes tripping leading to falls
  • Visual disturbances- falls are common in visually impaired individuals.  Conditions such as presbyopia, cataract, and glaucoma lead to increased chance of falls in old age
  • Coordination and balance- musculoskeletal impairments resulting in disorders of gait and lower extremity weakness leads to falls
  • Depression- studies show that people suffering from depression are tend to fall more due to antidepressant medication and decreased physical functioning.

Interventions to prevent falls include:

Strength and balance training

Older people tend to lose muscle strength as they grow old and few lose by decreased physical activity and the loss of strength in lower limb increases risk of falling.

Strengthening exercises that target lower limbs reduces falls.

Review medications

Medications are one the reasons for falls and are modifiable risk factor for falls. Medications which have effects on central nervous system leading to drowsiness, decreased reflexes are inappropriate for older age group.

Older age group who are on antidepressants and other psychotropic drugs should be reviewed regularly.

Sedatives which are prescribed for inducing sleep should be reduced and alternative strategies to enhance sleep can be effective in reducing falls

Vitamin D supplementation:

People aged over 65 years have low levels of hydroxyl vitamin D which is associated with loss of muscle strength and muscle mass and hip fractures. Intake of vitamin d supplementation may improve the bone mineral density and muscle function and in turn reduces the risk of fall

Vitamin D supplementation at doses of 700–1000 IU a day should be taken.

Vision assessment:

People with vision impairment are more likely to fall than those with normal sight. People suffering from altered depth perception, reduced visual field and poor distance vision are associated with falls. Proper assessment and correction will help in reducing the falls.

People who are wearers of multifocal glasses are at risk of falls because objects on the ground are viewed through lower segment of multifocal glasses leading to blurred vision and impaired depth perception.

Home hazard assessment and modification:

Most of the falls occur at residence of an individual, so proper assessment of home and modification reduces the risk of falls. This can be provided by experienced occupational therapist who can organize the changes according to an individual. These can be as simple as mat removal and installation of rails

Cardiovascular assessment: Impaired balance can be attributed to cardiovascular conditions, including dysrhythmias and vasculopathies. Regular cardiovascular checkups may help in intervention of such conditions.

By,

Dr.Chandrashekar

Reference:

https://www.bmj.com/content/353/bmj.i1419

https://www.aafp.org/afp/2005/0701/p81.html

https://bpac.org.nz/BPJ/2010/March/falls.aspx

 

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