Fall prevention

Fall prevention is a variety of actions to help reduce the number of accidental falls suffered by older people.

Falls and fall related injuries are among the most serious and common medical problems experienced by older adults. Nearly one-third of older persons fall each year, and half of them fall more than once.Moylan KC, Binder EF. Falls in older adults: risk assessment, management and prevention. "Am J Med". 2007;120(6):493.e1-6. PMID 17524747] Because of underlying osteoporosis and decreased mobility and reflexes, falls often result in hip fractures and other fractures, head injuries and even death in older adults. Accidental injuries are the fifth most common cause of death in older adults. In around 75% of hip fracture patients, recovery is incomplete and overall health deteriorates.

The most consistently proven predictors of fall risk are history of a fall during the past year and gait and balance abnormalities.Ganz DA, Bao Y, Shekelle PG, Rubenstein LZ. Will my patient fall? JAMA. 2007;297(1):77-86. PMID 17200478] Some studies (but not others) indicated that impaired vision, certain medications (especially psychotropic drugs)Hartikainen S, Lönnroos E, Louhivuori K. Medication as a risk factor for falls: critical systematic review. "J Gerontol A Biol Sci Med Sci". 2007;62(10):1172-81. PMID 17921433] , decreased activities of daily living and impaired cognition are associated with a higher risk of falls. The contribution of orthostatic hypotension to fall risk remains uncertain.

Fall Prevention Strategies and Interventions

Research indicates that multifactorial intervention programs can reduce the number of falls; in a meta-analysis of studies of older people in general the reduction was around 27%, and in those selected because of a previous fall or other risk factor there was a 14% reduction.Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH. Interventions for preventing falls in elderly people. Cochrane Database Syst Rev. 2003;(4):CD000340. [http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000340/frame.html Full text] ] Although further research is needed, preventative measures with the greatest likelihood of a positive effect include strength and balance training, home risk assessment, withdrawing psychotropic medication, cardiac pacing for those with carotid sinus hypersensitivity, Tai Chi. Tai Chi exercises have been shown to provide 47% reduction in falls in some studies but it does not improve measures of postural stability. Tai chi may gain its success, in part, from promoting confidence rather than primarily reducing the postural instability. [http://www.ptjournal.org/cgi/content/abstract/77/4/371]

Altering Eyeglass Selection and Usage

Bi-focal and tri-focal eyeglasses are commonly ground to provide refractory correction ideal for reading, that is, 12 to 24 inches, when the wearer is looking downward through them. These glasses, used for reading, are therefore not ideal for safe walking, where correction for 4 1/2 to 5 feet would be far more appropriate. Some countries with universal health care recommend separate reading and walking glasses, a rather rare practice in the U.S. in the early 21st Century.

Medical management (risk assessment and follow-up)

The aim of medical management is to identify factors that can contribute to falls and fracture risk such as osteoporosis, multiple medications, balance and gait problems, loss of vision and a history of falls. BEERS LIST is a list of medications that are potentially inappropriate for use in the elderly and some of them increase the risk of falls [http://mqa.dhs.state.tx.us/qmweb/MedSim/MedSimTable1.htm] .

Assessment of every fall should be aimed at identifying the inciting cause so that it can be avoided in future. If the fall is clearly without loss of consciousness, a "Get up and Go" test should be performed to assess the mobility and a thorough examination of musculoskeletal system should be performed to identify any contributory factors.

Balance and strength

Studies show that balance, flexibility, and strength training not only improve mobility but also reduce the risk of falling. The majority of older adults do not exercise regularly and 35% of people over the age of 65 do not participate in any leisurely physical activities. Many people who have already fallen simply stop exercising for fear of falling again.Fact|date=February 2008

Environmental modification

The home environment can present many hazards. Common places for injurious falls are the bathtub and steps. Changes to the home environment are aimed at reducing hazards and help support a person in daily activities. Changes could include minimizing clutter, installing grab bars in the shower or tub or near the toilet, and installing non-slip decals to slippery surfaces.Lin JT, Lane JM. Nonpharmacologic management of osteoporosis to minimize fracture risk. "Nat Clin Pract Rheumatol". 2008;4(1):20-5. PMID 18172445] Stairs can be improved by providing handrails on both sides, improving lighting, and adding color contrast between steps. Currently, there is insufficient scientific evidence to ensure the effectiveness of modification of the home environment to reduce injuries.Lyons RA, John A, Brophy S, "et al". Modification of the home environment for the reduction of injuries. "Cochrane Database Syst Rev". 2006;(4):CD003600. [http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003600/frame.html Full text] ] It appears that changes to the environment are not easily implemented because of low uptake by study participants.

See also

*Home Modifications
*Home automation for the elderly and disabled
*Assisted living
*

References

External links

* [http://www.profane.eu.org ProFaNE - Prevention of Falls Network Europe]
* [http://www.stopfalls.org/ Fall Prevention Center of Excellence] FPCE Program Office housed at the University of Southern California