Falls Prevention

Authors: Dr. Irene Li (MD) & Irene Poon, MScOT, Reg. OT

Falls in the elderly are major factors threatening the independence of older individuals and resulting in significant morbidity and mortality. Falls can result in injuries, ranging from minor soft tissue injuries, such as abrasions and bruises, to more severe injuries, such as fractures and head trauma. Approximately 5% of falls in older persons will lead to hospitalization. There is also considerable morbidity associated with falls, such as decline in functional status, loss of independence and increased likelihood of nursing home placement.

November is Falls Prevention Month. Let’s use this opportunity to get to know more about falls and how to reduce the risks of falls.

Why do people fall?

Falls in the elderly are usually multi-factorial. This often involves extrinsic stressors being superimposed on underlying intrinsic factors, such as age-related declines in balance, gait stability and cardiovascular function. These extrinsic stressors include medications, environmental changes, an acute illness or other factors. Please see the section below for various risk factors that increase the risk of falls.

Risk Factors

1. Female gender.

2. Age. The incidence of falls increases with age, with an estimated 1 in 4 adults aged 65 years and older reporting at least one fall in the preceding year and 1 in 3 aged 85 years and older reporting a falls incident in the past year.

3. Past history of fall. Nearly 60% of those with a history of fall in the previous year will have a subsequent fall.

4. Cognitive impairment.

5. Visual impairment.

6. Parkinson disease.

7. Balance issues.

8. Chronic musculoskeletal pain, weakness and arthritis

9. Orthostatic hypotension. Postural hypotension may lead to reduced perfusion of the brain, thereby increasing the risk of falls.

10. Anemia.

11. Medication use. This is one of the most modifiable risk factors for falls. Specifically, the specific types of medications, number of medications, recent changes in dose of medications are all associated with increased fall risk. Below is a list of medications that are commonly thought to increase the risk of falls. This list is not exhaustive. If you have any questions regarding your own medications, please consult with your doctor.

Certain psychoactive medications:

● Benzodiazepines i.e. lorazepam, diazepam, clonazepam

● Opioids

● Sedative-hypnotics i.e. zopiclone

● Antidepressants

● Anticonvulsants

● Antipsychotics

Other prescription medications, over-the-counter medications, and herbal supplements that may result in dizziness, sedation, blurred vision or orthostatic hypotension:

● Anticholinergics

● Antihistamines

● Antihypertensives

● Muscle relaxants

What do physicians do when evaluating a patient for falls risk?

Your doctor will ask you a detailed history to identify your risk factors for falls in order to come up with a plan to modify those risk factors. Please prepare a list of medications that you are taking, including over-the-counter medications and supplements. Be prepared to also discuss the details of any previous falls.

A physical examination will be done to evaluate your cardiovascular status, including orthostatic vital signs, as well as gait and musculoskeletal function. You may be asked to perform certain timed assessments in the office. Laboratory tests may also be done to evaluate your status for certain chronic diseases that increase your risk of falls, such as diabetes and anemia.

Who else on the healthcare team might I see to address falls prevention?

In addition to your physician, a physical therapist or an occupational therapist may both have potential roles to help evaluate and address your risk for falls. A physical therapist is interested in maintaining or gradually improving your strength, balance, and endurance. On the other hand, an occupational therapist may look at your habits and home arrangements to make sure you can continue your everyday schedules safely.

Is there anything I can do on my own?

If you would like to take some actions before seeing your doctor, here are some general tips to reduce your, or your loved one’s, risks to fall.

1 Listen to your body and know your limits.

• - If you fatigue easily, divide the tasks and take frequent short breaks in between.

2 Take your time

• - Take your time when changing posture. In the morning, take a few breaths (or count from 1 to 10) sitting at the edge of bed while warming up your joints, then take a few more breaths as you stand up on the floor, before moving.

• - Leave yourself enough time to get ready for what you have to do next.

3 Increase safety in the home

• - Increase lighting in areas such as stairs, porch, basement, etc.

• - Use a night light in between the bed(room) and bathroom.

• - Clear out items on the floor and maintain clear pathways as best you can.

• - Remove or tape down mats and carpets.

• - If you or your loved one experiences vision loss, use colored tapes to mark steps or ledges, to improve visibility and safety.

4 Wear proper footwear when going out or in the home

• - Look for shoes that are the right size and are not too soft in the sole, so that you can feel the ground conditions as you walk. This is especially important for walking on ice during the winter.

5 Create a schedule to regularly attend the washroom during the day if you experience urinary incontinence. Consider talking to your physician about your concern and please also ensure adequate water intake for your health needs!

6 Have a plan in place for how to get help if you fall and are unable to get up. This can be as easy as having a cell phone on you at all times and knowing who to call when it happens.

7 The height and dimensions of walking aids, or mobility devices, matter. Please contact your physician, occupational therapist, or physical therapist for more information.

Note that more specific recommendations can be made by your healthcare providers to individual situations.

Conclusion

Many factors can contribute to higher risk of falls. By recognizing the presence of signs and risks of falls, we can take early actions to not only reduce the possibility of severe fall injuries, but to also increase the quality of your everyday life.

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Does good posture matter?

References Up To Date – Falls in older persons: risk factors and patient evaluation

https://www.uptodate.com/contents/falls-in-older-persons-risk-factors-and-patient-evaluation?search=falls%20in%20elderly%20adult&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H21

Mayo Clinic – Falls prevention: simple tips to prevent falls

https://www.mayoclinic.org/healthy-lifestyle/healthy-aging/in-depth/fall-prevention/art-20047358 Lundebjerg, N. (2001, May 1). Guideline for the prevention of falls in older persons. Journal of the American Geriatrics Society. John Wiley & Sons, Ltd. https://doi.org/10.1046/j.1532-5415.2001.49115.x

American Occupational Therapist Association. (2012). Fall Prevention for Older Adults. https://www.aota.org/-/media/Corporate/Files/AboutOT/consumers/Adults/Falls/Fall%20Prevention%20Tip%20Sheet.pdf

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These presentations are intended for general information purposes only. Audience are recommended to consult with qualified healthcare provider and obtain professional advice and subsequent management for your particular conditions. The views and opinions expressed by the speakers do not necessarily reflect the policy or position of Assisting in Medical Expectations.