PREVENT FALLS IN ELDERLY

Quick Facts...

• The risk of falling increases with age and is greater for women than for men.
• Two-thirds of those who experience a fall will fall again within six months.
• A decrease in bone density contributes to falls and resultant injuries.
• Failure to exercise regularly results in poor muscle tone, decreased strength, and loss of bone mass and flexibility.
• At least one-third of all falls in the elderly involve environmental hazards in the home

Nearly a third of the elderly have falls that trigger a chain of events that usually have them succumb to the situation or leave them bed-ridden till the end comes. With age, the ability of the body to heal itself reduces considerably and the immunity drops. The muscles and ligaments tend to get more lax with bones becoming more brittle and porous. Under these circumstances, even a trivial looking fall may prove fatal.

The external environment plays a major role in triggering such an event. Slippery ground surfaces, poor lighting, high stairs, improperly placed furniture, and ill-fitting footwear are some of the commonest causes of falls. Certain medicines, especially those that are given to induce sleep or to decrease the blood pressure, blood sugar, or fluid in the body, are known to give rise to giddiness and lead to falls too. Rising up after straining to pass stool or urine can cause a drop in the blood pressure due to a decrease in the pressure within the abdomen, thereby causing a blackout, medically known as syncope.

Advancing age ushers in a gamut of diseases in almost each and every system. These could also be contributory in causing dizziness, blackouts, or a sense of imbalance. Cerebellar degeneration, transient ischemic attacks (TIA), Parkinson's, vitamin B12 deficiency, and sensory impairment are some conditions of the nervous system and rhythm disturbances of the heart, hypotension, or ischemic heart disease are conditions of the cardiovascular system that can lead to falls. Malnutrition, dehydration, or electrolyte imbalances can also give rise to the same.

The commonest complication of a fall is head injury that can lead to bleeding within the skull, brain damage, fractures, and secondary infection as a result of immobilization due to the trauma or because of anxiety, where the patient voluntarily reduces his activities to the bare minimum in an attempt to protect himself against another fall. This also mars the confidence levels of the patient, making him perceive his own health in extremely poor light.

A detailed history is a must to ascertain the cause of the fall in the elderly. The location and activity at the time of the fall; the symptoms associated with it such as giddiness, increased heartbeats, breathlessness, chest pain, mental confusion, unconsciousness, weakness, involuntary passage of stool or urine, diarrhea, and vomiting; medical history with regard to conditions like diabetes, heart disease, and convulsions or habits such as alcoholism, tobacco abuse, or drug addiction.

Management of a fall should involve ruling out any brain injury first by doing a CT scan. The cause of the problem must be dealt with firmly and in the case of a fracture, physiotherapy exercises must be done to prevent joint stiffness. The patient should be encouraged to stay ambulatory under all circumstances. Following this, proper rehabilitative care should be given to reduce the chances of another future.

Some factors that can contribute to a fall and can be prevented are as follows:

Factor #1: Osteoporosis

Osteoporosis is a condition wherein bones become more porous, less resistant to stress, and more prone to fractures. Caused by hormonal changes, calcium and vitamin D deficiency, and a decrease in physical activity, osteoporosis is a chief cause of fractures in older adults, especially among women.
What is debatable is whether brittle bones break after a fall, or break when stressed and in turn cause a fall. In either event, a decrease in bone density contributes to falls and resultant injuries.

Prevention Tips

• Eat or drink sufficient calcium. Postmenopausal women need 1,500 mg of calcium daily. Calcium-rich foods include milk, yogurt, cheese, fish and shellfish, selected vegetables such as broccoli, soybeans, collards and turnip greens, tofu and almonds.
• Get sufficient vitamin D in order to enhance the absorption of calcium into the bloodstream. Vitamin D is formed naturally in the body after exposure to sunlight, but some older adults may need a supplement.
• Regularly do weight-bearing exercises.

Factor #2: Lack of Physical Activity

Failure to exercise regularly results in poor muscle tone, decreased strength, and loss of bone mass and flexibility. All contribute to falls and the severity of injury due to falls.

Prevention Tips

• Engage regularly (e.g., every other day for about 15 minutes daily) in exercise designed to increase muscle and bone strength, and to improve balance and flexibility. Many people enjoy walking and swimming.
• Undertake daily activities in a safe manner, such as reaching and bending properly, taking time to recover balance when rising from a chair or bed, learning the proper way to fall, and learning how to recover after a fall.
• Wear proper fitting, supportive shoes with low heels or rubber soles.

Factor #3: Impaired Vision

Age-related vision diseases can increase the risk of falling. Cataracts and glaucoma alter older people's depth perception, visual acuity, peripheral vision and susceptibility to glare. These limitations hinder their ability to safely negotiate their environment, whether it be in their own home or in a shopping mall. Young people use visual cues to perceive an imminent fall and take corrective action. Older adults with visual impairments do not have this advantage to the same extent.

Prevention Tips

• Have regular checkups by an ophthalmologist to discern the extent of age-related eye diseases such as cataracts and glaucoma.
• Use color and contrast to define balance-aiding objects in the home (e.g., grab bars and handrails).
• Add contrasting color strips to first and last steps to identify change of level.
• Clean eye glasses often to improve visibility.

Factor #4: Medications

Sedatives, anti-depressants, and anti-psychotic drugs can contribute to falls by reducing mental alertness, worsening balance and gait, and causing drops in systolic blood pressure while standing. Additionally, people taking multiple medications are at greater risk of falling.

Prevention Tips

• Know the common side effects of all medications taken.
• Talk with your physician or pharmacist about ways to reduce your chances of falling by using the lowest effective dosage, regularly assessing the need for continued medication, and the need for walking aids while taking medications that affect balance.
• Remove all out-of-date medications and those no longer in use.
• Have a physician conduct a  medicine review of all current medications.
• Limit intake of alcohol as it may interact with medications.

Factor #5: Environmental Hazards

At least one-third of all falls in the elderly involve environmental hazards in the home. The most common hazard for falls is tripping over objects on the floor. Other factors include poor lighting, loose rugs, lack of grab bars or poorly located/mounted grab bars, and unsturdy furniture.

Prevention Tips

It is useful to conduct a walk-through of your home to identify possible problems that may lead to falling. A home visit by an interior designer or occupational therapist might also be useful in that they are trained to identify risk factors and recommend appropriate actions.


Outdoors

• Repair cracks and abrupt edges of sidewalks and driveways.
• Install handrails on stairs and steps.
• Remove high doorway thresholds Trim shrubbery along the pathway to the home.
• Keep walk areas clear of clutter, rocks and tools.
• Keep walk areas clear of snow and ice.
• Install adequate lighting by doorways and along walkways leading to doors.

All Living Spaces

• Use a change in color to denote changes in surface types or levels.
• Secure rugs with nonskid tape as well as carpet edges.
• Avoid throw rugs.
• Remove oversized furniture and objects.
• Have at least one phone extension in each level of the home and post. emergency numbers at each phone.
• Add electrical outlets.
• Reduce clutter.
• Check lighting for adequate illumination and glare control.
• Maintain nightlights or motion-sensitive lighting throughout home.
• Use contrast in paint, furniture and carpet colors.
• Install electronic emergency response system if needed.

Bathrooms

• Install grab bars on walls around the tub and beside the toilet, strong enough to hold your weight.
• Add nonskid mats or appliques to bathtubs.
• Mount liquid soap dispenser on the bathtub-wall.
• Install a portable, hand-held shower head.
• Add a padded bath or shower seat.
• Install a raised toilet seat if needed.
• Use nonskid mats or carpet on floor surfaces that may get wet.

Kitchen

• Keep commonly used items within easy reach.
• Use a sturdy step stool when you need something from a high shelf.
• Make sure appliance cords are out of the way.
• Avoid using floor polish or wax in order to reduce slick surfaces.

Living, Dining and Family Rooms

• Keep electrical and telephone cords out of the way.
• Arrange furniture so that you can easily move around it (especially low coffee tables).
• Make sure chairs and couches are easy to get in and out of.
• Remove caster wheels from furniture.
• Use television remote control and cordless phone.

Bedroom

• Put in a bedside light with a switch that is easy to turn on and off (or a touch lamp).
• Have a nightlight.
• Locate telephone within reach of bed.
• Adjust height of bed to make it easy to get in and out of.
• Have a firm chair, with arms, to sit and dress.

Stairways, Hallways and Pathways

• Keep free of clutter
• Make sure carpet is secured and get rid of throw rugs.
• Install tightly fastened hand rails running the entire length and along both sides of stairs.
• Handrails should be 34 inches high and have a diameter of about 1.5 inches.
• Apply brightly colored tape to the face of the steps to make them more visible.
• Optimal stair dimensions are 7.2 inch riser heights with either an 11 or 12 inch tread width.
• Have adequate lighting in stairways, hallways and pathways, with light switches placed at each end.

Please have a regular check up.

Essential Features of a Physical Exam from Your Doctor:

• Vital Signs
• Mental Status Testing
• Cardiac
• Musculoskeletal
• Neurologic
• Proprioception
• Vision
• Hearing
• Gait and balance testing

Statistics

• The risk of falling increases with age and is greater for women than men.
• Annually, falls are reported by one-third of all people 65 and older.
• Two-thirds of those who fall will fall again within six months.
• Falls are the leading cause of death from injury among people 65 or over.
• Majority of deaths in older people are associated with falls each year. The elderly account for seventy-five percent of deaths from falls.
• More than half of all fatal falls involve people 75 or over, only 4 percent of the total population.
• Among people 65 to 69, one out of every 200 falls results in a hip fracture, and among those 85 or over, one fall in 10 results in a hip fracture.
• One-fourth of those who fracture a hip die within six months of the injury.
• The most profound effect of falling is the loss of independent functioning. Twenty-five percent of those who fracture a hip require life-long nursing care. About 50 percent of the elderly who sustain a fall-related injury will be discharged to a nursing home rather than return home.
• Most falls do not result in serious injury. However, there is often a psychological impact. Approximately 25 percent of community-dwelling people 75 or over unnecessarily restrict their activities because of fear of falling.
• The majority of the lifetime cost of injury for people 65 or over can be attributed to falls.