Falls Can Be Prevented
By Dr. Cindy Cullinane

Falls are among the most common and serious problems facing elderly persons. Approximately one-third of men and women over 65 years of age suffer a fall each year and, in many cases, the fall leads to bone fractures.

Patients who have fallen in the past may suffer from post fall anxiety, which limits the amount of time spent outside the home. Frequently, older people are not aware of their risks of falling and do not recognize risk factors nor report these to their physician.

In order to prevent falls and subsequent fractures, older adults need to understand the risk factors for falling. Risk factors are related to the person (intrinsic) or to their environment (extrinsic).

INTRINSIC RISK FACTORS

As men and women age they are at risk for weakness of the hip flexor muscles and lower extremities. Signs of this are the need to push off the arms of a chair to rise from a seated position or to adjust the feet to uneven surfaces.

Balance disorders are also common and make it more difficult for older persons to react to minor trips. And, as we age, our vision is often impaired by problems such as macular degeneration and cataracts which make it more difficult to see (i.e. when negotiating stairs or stepping into or out of a car). Prior strokes, Parkinson’s Disease and arthritis can contribute to problems with how we walk, thereby increasing the chance of falling.

Fortunately, we can reduce some of these intrinsic problems with activities that improve strength and balance. Physical therapy with gait training and an exercise called Tai-Chi have both been shown to reduce falls. It is also important to discuss with your doctor whether or not there are any treatable medical problems such as vitamin B12 deficiency or low blood pressure which may contribute to or exacerbate balance problems.

Avoiding unnecessary medications and medications which are known to increase the risk of falling is critical. Tranquilizers, sleeping pills and anti-anxiety drugs are known to increase falls; there are other newer medications that your doctor may want to prescribe instead which are safer.

Try to take diuretics (like lasix) in the morning so that you are not required to make many trips to the bathroom during the night when your risk of falling might be greater. And beware of Benadryl which is in cold pills and Tylenol PM which can make older people confused and unsteady on their feet.

When men and women fall, their risk of bone fractures is greater if their bones are weak from osteoporosis. Make sure that you are up to date with your bone density testing and that your vitamin D levels are adequate.

Vitamin D enables you to absorb calcium from your diet. Men and pre-menopausal women should take in at least 1000 mg of calcium per day and post-menopausal women need at least 1500 mg per day.

EXTRINSIC RISK FACTORS

Poor lighting, loose carpets and lack of bathroom safety equipment are among the most common factors contributing to falls. Your local visiting nurse can perform a home safety evaluation and recommend how to remove trip hazards, improve lighting (especially at night), and can help with the installation of grab bars in the bathroom and stairways.

While we often cannot change impaired vision and arthritis, the use of appropriate assist devices such as canes and walkers can be used to steady our gait. And for those in the hospital or the nursing home, restraints are sometimes used.

Restraints however can actually contribute to fall-related injuries by reducing a patient’s freedom of movement which leads to muscle weakness and reduces physical function.

In summary, falls are common and can result in fractures which are associated with significant morbidity and mortality. The risk of falling can be reduced with gait and balance training, improved vision, assist devices such as walkers and canes and through minimization of unnecessary or harmful medications. The home environment, where most injurious falls occur, can be assessed and fall hazards can be removed and lighting improved. Above all, discuss your bone health with your physician so that if you do fall, you lessen your chances of bone fractures. If you have any concerns, discuss them with your doctor. A geriatrician or rehabilitation doctor might be able to assist in the evaluation of your gait if necessary.