What is Falls and Fall Prevention in Older Adults?
Falls are one of the most common and serious problems leading to disability, especially in older people. In 1988, a researcher named Tinetti and his team defined a fall as an incident where someone ends up on the ground or another lower level without meaning to. This doesn’t include falling due to major health events like a stroke or a big accident. Falls are directly linked to higher rates of death, illness, and loss of physical function. They happen frequently in older adults, children, and athletes. For older adults, having other health problems can increase the chance of falling, and therefore, the risk of getting injured.
What Causes Falls and Fall Prevention in Older Adults?
Walking normally is the result of different parts of our brain working together, as well as our muscles and our ability to process sensory information such as what we see, hear, and feel. The risk of falling increases as we get older due to several reasons: our brain and muscle functions decline with age, we’re more likely to have health problems, and we’re often using more medications.
As we age, we tend to walk with a wider stance and slower speed, take smaller steps, and our leg strength decreases. A fall usually happens when long-term factors like these interact with immediate factors like side effects of medication, sudden illness, or tripping on uneven ground.
Several factors increase the risk of falling, in order of how strongly they increased the fall risk, include having a history of falls, loss of balance, loss of muscle strength, vision problems, using four or more medications or psychoactive drugs, difficulty in walking, feeling depressed, feeling dizzy, physical limitations, being over 80, being female, urinary incontiness, cognitive problems, arthritis, diabetes, and pain.
As the number of these risk factors increase, the chance of falling also increase. The risk of falling within a year doubles for every risk factor a person has. So, it starts at 8% with no risk factors and can go up to 78% if a person has four risk factors. Certain medications can also increase the risk of falls, such as blood pressure medications, antipsychotic medications, sedatives, antidepressants, anti-inflammatory pain relievers, and benzodiazepines.
Risk Factors and Frequency for Falls and Fall Prevention in Older Adults
Falling is quite common among older individuals, especially those over 65. Each year, over 30% of people in this age group experience a fall. The situation intensifies for those aged 85 and above, with about 40% of them having recurrent falls. These are not minor incidents; around 10% of these falls cause severe injuries like hip fractures, other bone fractures, traumatic brain injury, or subdural hematoma, which is bleeding in the brain. These mishaps make falls the number one accident among folks aged 65 and older and a primary reason for hospitalizations due to injury in that group. Falls often bring more problems with them. For instance, they can lead to higher death rates, increased use of ambulance services, the need for social care, and more hospital care. All these aspects can result in substantial financial costs.
Signs and Symptoms of Falls and Fall Prevention in Older Adults
When trying to determine the reason an individual has fallen, personal factors (intrinsic causes) and external factors (extrinsic causes) need to be taken into account. A person’s medical history, lifestyle, and even characteristics such as age, gender, and race can all play a part.
Intrinsic Causes:
- Previous falls: Recurring falls can suggest a higher risk of future falls.
- Age: Older age can slow reaction times, making falls more likely.
- Gender: Studies suggest that among the elderly, women tend to fall more than men.
- Race: Whites reportedly fall more often than Africans, Caribbeans, Hispanics, and South Asians.
- Medications: Taking four or more can significantly increase the risk of falling. Certain drugs like benzodiazepines, antiarrhythmics, digoxin, diuretics, sedatives, and psychotropics can also hike up the risk.
- Solitary lifestyle: Living alone can not only increase the risk of falling, but it can make the consequences of a fall worse if there’s no one around to help afterwards.
Multiple medical conditions can also raise the risks of falling. These include vascular diseases, arthritis, thyroid dysfunction, diabetes, depression, and chronic obstructive pulmonary disease. Those who experience vertigo and incontinence also have a higher fall risk, as do those who have impaired mobility or live largely sedentary lifestyles. Finally, fear of falling and poor nutrition can both negatively influence an individual’s risk as well.
Extrinsic Causes:
Environmental factors like poor lighting, uneven floors, or slippery surfaces can contribute significantly to falls in older adults. Difficulty navigating one’s environment is a common cause of falls in the elderly.
When a patient is examined after a fall, the focus is typically on factors that could contribute to an increased risk. These might include changes in blood pressure, foot deformities, or issues with vision or the nervous system. Generally, the goal is to identify and address potential weaknesses.
Despite the use of multiple screening tools, there is no foolproof method for assessing an individual’s fall risk. However, understanding a person’s everyday activities and lifestyle can provide insight into their risk level. Elements such as personal grooming, preparing meals, managing finances, and moving around the house are all taken into account in these assessments.
Testing for Falls and Fall Prevention in Older Adults
When it comes to preventing and managing falls, especially in older people, a well-rounded approach involving multiple healthcare professionals is needed. One such approach is the Comprehensive Geriatric Assessment (CGA). This is a detailed evaluation performed by a team of healthcare experts to assess older patients who might be at a higher risk of falling.
Aside from taking a detailed history and physical examination, other aspects of the CGA include assessing patients’ pain levels using a visual chart and reviewing the medications they are on. Various tests or scales are used during this evaluation. For instance, the Berg Balance Scale checks a patient’s ability to maintain balance while standing still or moving, the Falls Efficacy Scale measures how much patients fear falling, and the Timed Up and Go Test looks at how mobile a patient is. Other potential tests include the 6-minute Walking Test and the 10 meters Walking test, which check walking ability and are used as needed.
In terms of diagnostic tests for identifying individuals at high risk for falls, there’s no one-size-fits-all approach. However, depending on the patient’s history and physical examination, various laboratory tests may be useful. These can check for things like electrolyte levels, blood sugar, and hemoglobin levels that can help point to causes of falls like dehydration, anemia, or diabetes. Vitamin D levels can also be checked, as these can help to identify patients who might benefit from added Vitamin D.
Treatment Options for Falls and Fall Prevention in Older Adults
Managing falls can be a complex process, especially in aging individuals, and usually involves a combination of treatments. These could include a review of medications, a tailored exercise program, vitamin D supplements, and an assessment of the home. Since the reasons why someone may fall can vary greatly, it’s important for each person’s treatment plan to be individually tailored based on their specific needs.
An exercise program is a key component of any fall management plan, and there is a range of exercises that have been found to be beneficial. These include endurance exercises, platform balance exercises, tai chi, resistance training, and flexibility exercises. Tai chi, in particular, has been found to be very beneficial to improve balance, but may not be suitable for those with a history of fractures.
Other effective exercise strategies to prevent falls might include walking heel-to-toe and balancing on one foot. These exercises, combined with coordination exercises, can help improve stability and prevent falls.
Medication reviews can also be an important part of fall management. Some medications can increase a person’s risk of falling, especially if they are taking four or more different forms of medication or are using certain types of medicine such as antidepressants, sedatives, and hypnotics. It’s important for doctors to check all medications a patient is taking if this patient has experienced a fall. If necessary, doctors can eliminate or replace medications that may contribute to fall risks.
Vitamin D supplements are sometimes recommended as well, as they aid muscle strength and balance. These supplements, when taken daily, can significantly reduce the risk of falls.
In some cases, a single form of intervention may not be enough to prevent falls. For people with multiple risk factors, a tailored treatment plan that includes a mix of different interventions may be more effective. This could include home safety modifications, vitamin D supplements, and tailored exercise programs. Clinics that offer a specialized team for fall prevention can also be a valuable resource to help reduce the risk and impact of falls.
What else can Falls and Fall Prevention in Older Adults be?
Falling can sometimes be a symptom of an underlying condition. That’s why it’s important to consider any symptoms that occurred both before and after the fall, in order to help diagnose any potential health problems.
If a fall happens out of the blue and wasn’t caused by a slip or trip, it’s quite likely that the person may have experienced a sudden loss of consciousness, a condition known as syncope. If syncope is suspected, further tests should be carried out to find its cause.
There are also a number of other conditions that could cause someone to fall:
- Transient ischemic attack (TIA)
- Stroke
- Seizure
- Acute coronary syndrome
- Orthostatic hypotension
- Arrhythmia
- Pulmonary embolism
- Endocrine disorders
- Metabolic problems
- Infection or Sepsis
For older adults, difficulties with memory may make it hard to remember the details of the fall, such as any symptoms they felt beforehand or if they lost consciousness. Without a witness, it can be tough to determine whether the fall was due to syncope, a TIA, or epilepsy. Combining a complete history and physical exam findings can help to narrow down the possible causes.
What to expect with Falls and Fall Prevention in Older Adults
Falls can be a significant issue for older adults. Repeated falls can increase health complications and death rates among this group. It can also lead to earlier than expected moves into nursing homes and can limit daily living activities. Considering the physical, emotional, and mental stress caused by falls, it is advised to take preventive measures as early as possible.
Possible Complications When Diagnosed with Falls and Fall Prevention in Older Adults
Falls can lead to various complications such as hospital stays, broken bones, brain injuries, a condition called subdural hematoma (bleeding on the brain), pain, and even the need for surgery. They may also decrease a person’s ability to perform daily tasks and create a fear of falling. In many cases, these issues can result in admission to a care home and a decrease in their overall quality of life.
Common Side Effects:
- Hospitalization
- Fractures or broken bones
- Traumatic brain injuries
- Subdural hematoma (bleeding on the brain)
- Pain
- Admission to a care home
- Surgical intervention
- Decreased overall functionality in daily tasks
- Fear of falling
- Poor quality of life
Preventing Falls and Fall Prevention in Older Adults
Teaching patients how to prevent falls is extremely important. Here’s some information that we can provide to patients:
* A workout routine to do at home
* Tips to make their home safer
* Dietary suggestions
* Details about their medications and possible side effects
* Emergency phone numbers
* Techniques to improve balance
These guidelines can significantly reduce the risk of falls, thereby improving patient safety.
