Falls are one of the most common health problems experienced by older adults and are a common cause of loss of functional independence. Studies show that unintended injuries are the fifth leading cause of death in the elderly, and falls cause about two-thirds of those injuries. Fortunately, research continues to evolve in fall prevention. In the January 13, 2011 online issue of the Journal of the American Geriatrics Society, the American Geriatrics Society (AGS) and the British Geriatric Society (BGS) updated the 2001 guideline on preventing falls in older persons based on an accumulation of new data and a literature review.
Assessing Fall Risk Factors
The first step in preventing falls is to determine if patients are at increased risk. The updated AGS/BGS guidelines recommend that yearly evaluations of elderly patients include questions about any recent falls as well as inquiries about balance and steadiness of gait. Balance and steadiness represent a new addition to the guidelines. These problems can result from a number of causes, so it’s important that physicians consider what may be contributing to the problem before recommending treatment. Patients should also be asked about side effects of any medications that may increase fall risk. Questions about a patient’s comfort with activities of daily living may also reveal areas of concern. If a patient has already sustained a fall, physicians should assess and treat any resulting injuries, evaluate what contributed to the fall, and then recommend interventions to prevent future falls.
Take Preventive Measures to Reduce Falls
In many cases, preventive measures can be taken to reduce the likelihood of falls. The appropriate course of action will often be multifactorial and dependent on specific individual circumstances for each patient. The AGS/BGS guideline update has identified several interventions that may benefit elderly patients in fall prevention:
Exercise: Because many falls are the result of muscle weakness and unsteady gait, patients often benefit from strength training and other physical conditioning to improve strength, balance, and flexibility. A physical therapist should be consulted to develop appropriate exercise programs or to serve as an intermediate for patients electing to exercise independently.
Medications: Review patients’ medications at each visit and evaluate them for their possible contribution to poor balance or unsteadiness. Of specific concern are medications that can cause sedation, confusion, or orthostatic hypotension.
Sensory Impairments: Patients should have annual vision screenings to detect any problems so that appropriate interventions can be administered.
Environment: Assessment and correction of risk factors in the home and daily life can greatly reduce the likelihood of falls. Orthotic devices or installation of grab bars in the bathroom may help improve steadiness.
Vitamin D: Vitamin D supplementation has been shown to decrease the incidence of falls in elderly patients with inadequate levels.
Risk Factor Detection
The updated AGS/BGS guidelines for fall prevention can assist clinicians who are managing this patient group. The development and validation of risk factor detection instruments in office settings and patient self-screening forms require more study, but existing versions may enable physicians to further enhance fall prevention efforts. In the meantime, physicians should be vigilant about assessing risk factors and encouraging the use of lifestyle modifications to prevent falls.
Readings & Resources (click to view)
Panel on Prevention of Falls in Older Persons, American Geriatrics Society, and British Geriatrics Society. Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011;59:148-157. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2010.03234.x/abstract.
Hartholt KA, van Beeck EF, Polinder S, et al. Societal consequences of falls in the older population: injuries, healthcare costs, and long-term reduced quality of life. J Trauma. 2010 [Epub ahead of print].
Dykes PC, Carroll DL, Hurley A, et al. Fall prevention in acute care hospitals: a randomized trial. JAMA. 2010;304:1912-1918.
Annweiler C, Montero-Odasso M, Schott AM, Berrut G, Fantino B, Beauchet O. Fall prevention and vitamin D in the elderly: an overview of the key role of the non-bone effects. J Neuroeng Rehabil. 2010;7:50.
Pynoos J, Steinman BA, Nguyen AQ. Environmental assessment and modification as fall-prevention strategies for older adults. Clin Geriatr Med. 2010;26:633-644.
Kelsey JL, Berry SD, Procter-Gray E, et al. Indoor and outdoor falls in older adults are different: the maintenance of balance, independent living, intellect, and Zest in the Elderly of Boston Study. J Am Geriatr Soc. 2010;58:2135-2141.
Miller KL, Magel JR, Hayes JG. The effects of a home-based exercise program on balance confidence, balance performance, and gait in debilitated, ambulatory community-dwelling older adults: a pilot study.J Geriatr Phys Ther. 2010;33:85-91.
Robertson K, Logan PA, Conroy S, et al. Thinking falls – taking action: a guide to action for falls prevention. Br J Community Nurs. 2010;15:406-410.