Age should not be the reason older adults fall, it is only a small risk factor.
Did you know that falls are one of the most common events that threaten the independence of older adults? Complications of falls are the leading cause of death from injury in people 65 years of age and older.
1 in 3 adults 65 years and older reports falling each year
One half of those falls are adults over the age of 80
This includes one-half of nursing home residents
About 5-10% of the time when an older adult falls they end up with a broken bone or head trauma possibly resulting in:
Functional loss
Nursing home placement
Need to start using some type of medical device such as a walker
Fear of falling
Unfortunately, up to 20% of patients who break a hip due to a fall die within the first year after their fall, and up to 50% lose their independence completely.
So Why do older adults fall?
The risk of falls increases with the number of risk factors associated with falls
Risk Factors Associated with falls
Older Age
Dementia
Older women have higher risk of falling than men
History of Fall
Leg weakness
Food disorders that can cause changes in the shape of the feet
Problems with balance,
Low vitamin D, and Vitamin B12 levels
Pain
Parkinson’s disease
stroke
Arthritis
Use of multiple medications also called polypharmacy
Risk of recent prolonged hospitalization leading to weakness
Risk of new changes to medications
Poor vision
Heart problems
Numbness and tingling in feet also called neuropathy
Low blood pressure with standing
Dizziness due to inner ear problems
Environmental hazards such as poor lighting, slippery floors, cords etc.
How can medications increase a person’s risk for falling?
In my experience as a geriatric physician, what I see is that as we age, we accumulate more medicine. This is likely because as we age, we may develop high blood pressure, cholesterol issues, heart disease, type 2 diabetes and on and on. Older adults are at risk for polypharmacy, the main definition of this word is taking 5 or more medications. As the number of medications increases so does the risks for falls. Some medications are more likely to increase an older adult’s risk of falling than others. Specific classes of medications that can increase risk of falling include:
Anti-anxiety medications
Sedating medications such as sleeping medications or certain allergy medications and others.
Antidepressants
Antipsychotics potentially causing confusion, sleepiness
Heart medications potentially causing low blood pressures, or low pulse
Diabetes medications potentially causing low blood sugars
Can doctors help decrease or prevent falls?
The answer to this question is yes!
As a Geriatrician I often evaluate patients for falls. Geriatricians can partner with physical, occupational therapists and pharmacists and take a team approach to help decrease the risk of falls in a fall clinic setting. As part of a fall clinic evaluation patients are seen by the doctor, the therapist and pharmacist. The fall clinic team then meets with the patient to discuss patient specific risk factors, and an approach to decrease or eliminate fall risks. A fall evaluation includes the following:
Gathering a full fall history, including activities at the time of fall(s), Location and time of fall(s), any witnesses that can provide additional history, dizziness with positional changes, loss of consciousness
Full Medical history- we review all medical problems, and all medications including dose of medications, recent medication changes.
Environmental history- ask about lighting, floor coverings, railings, furniture, door thresholds, footwear, small pets, hallways
Medical examination- Including blood pressures laying, sitting, and standing, head to toe exam by the doctor
Physical or occupational therapy examination- includes strength testing, evaluation of walking and speed, assessment of confidence and fears associated with walking
Patient is provided with education, and a patient centered approach to fall reduction and prevention is established based on findings. This can include making recommendations for medication adjustments, blood work, referral to physical therapy, use of a medical device, vitamin supplementation, modifying home environment, managing foot problems, and footwear, treating vision impairment etc.
Patients are then asked to return after implementation of initial recommendations later and retested to measure progress.
Consider moving environmental hazards that can increase your risk of falling:
Ensure there is adequate lighting, consider leaving hallway lights on at night
Clear Cluttered hallways, and push aside small pieces of furniture
Remove unnecessary electric cords, more cords out of the way, try to stay clear of oxygen cords
Remove small area rugs
Use non-slip mats on surfaces that can get slippery surfaces
Ensure there are railings around steps
Small pieces of furniture such as foot stools, coffee tables.
Use of foot stools- try not to place objects high enough so that you need to use a foot stool
Small pets maybe don’t get rid of your furry friend but we aware to be careful.
I hope that the information provided in this blog was educational and provided some encouragement. I am often bothered when I see a patient who tells me they were told they fall because they are old. Addressing the reasons that increase a person’s risk of falling can decrease and prevent falls, but more importantly ensure they remain functional and independent.
Consider addressing some of the environmental hazards that can increase your risk of falling:
Poor lighting
Cluttered hallways
Cords and wires such as electric and oxygen cords
Small area rugs
Slippery surfaces
Small pieces of furniture such as foot stools, coffee tables.
Use of foot stools- try not o place objects high enough so that you need to use a foot stool
Small pets maybe don’t get rid of your furry friend but we aware to be careful.
Please check out other blog posts related to aging on GeriAcademy.com and email me with any topic suggestions you would like general information on.