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Preventing Falls in Older Age Is Essential

Philip Moeller

When seniors visit the doctor, one of the mandatory questions they're asked is whether they've fallen recently. Tumbles which would be trivial at younger ages are anything but that as we get older. In addition to possible injuries from the fall itself, the fact that an older person has fallen could indicate any number of possibly more serious physical problems.

Guidelines from the American Geriatrics Society (AGS) provide solid, research-backed advice for how to treat falls and, perhaps of greater importance, how to avoid them in the first place. The preventive steps are relatively easy for seniors, their families, and their physicians to put into place. Let's repeat the key words here--preventive and easy, for seniors and their families.

One out of three people age 65 and older fall each year, and the odds rise to 70 percent and even higher for the oldest age groups, according to research findings distributed by the AGS. Roughly an eighth of all falls lead to serious injuries, with a total price tag of nearly $20 billion in medical bills and an average hospital bill of $17,500 for seniors who require hospitalization.

Not included in these numbers are the ways falls can cause seniors to change their lifestyle, reduce trips outside the home, and become less independent and socially active. According to Sharon A. Brangman, former AGS President, seniors often compound the impact of a fall by not disclosing it to family members or their doctors because they fear losing independence. Ironically, she says, such secrecy can prevent them from receiving relatively simple treatments and preventive measures, and thus may hasten the loss of independence.

The AGS guidelines, revised two years ago, were the profession's first updates since 2001. The earlier guidelines tended to be supported by common geriatric treatments and common sense. The newer ones benefit from extensive research that did not exist a decade ago.

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"Eleven years ago, we didn't have a lot of research to back up the anecdotal things we thought were important," she says. For example, vitamin D was thought to be helpful in maintaining senior balance and reducing the risk of falls. Now, it's much more strongly recommended. Physical exercise, specifically including tai chi and strength and cardiovascular training, has similarly emerged in research studies as a major way to reduce falls.

Often, the AGS notes, seniors have multiple conditions or symptoms that make them prone to falls. Accordingly, doctors and other health professionals are advised to develop interventions with multiple components. Here are some of the major intervention areas included in the guidelines. They apply to seniors living in private homes and not in institutional settings. Research findings for nursing homes and other care facilities are less conclusive, the AGS notes, at least in part because people in those settings often have severe physical and mental infirmities that prevent them from following steps that would minimize falls.

Medications. Excessive medications, particularly of psychotropic drugs, is a leading cause of falls. "Medications are the No. 1 issue, at least from my perspective," Brangman says. "As we get older, the medications we take may have cumulative effects" that lead to "unforeseen side effects." Also, medications often are prescribed by different doctors that a senior may be seeing, and there can be a lack of communication and awareness of the combined effects of the drugs.

In addition, Brangman says, the clinical trials of many drugs given to seniors involve not older people, but "relatively healthy younger adults." Seniors and their families should be particularly aggressive about their medication needs. "They need to know what medications they are taking or their parents are taking," she says. "These medications should be discussed every time they visit their doctors to make sure the medication is still needed and that they are taking the smallest dose" that is suitable.

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Customized exercise program. "Because a large body of evidence supports the recommendation that exercise, in the form of resistance (strength) training and balance, gait, and coordination training, is effective in reducing falls," the guidelines say, such programs are recommended for multicomponent interventions or as a single program.

Vision impairment. "Aging is often associated with changes in visual acuity, development of cataracts, macular degeneration, glaucoma, and other conditions that would suggest an effect on risk of falling," the guidelines say. Vision concerns should be followed up with formal assessment and suggested treatment, particularly for cataracts.

Dizziness. When older people shift positions, and particularly when they rise from a seated position, it's not uncommon for their blood pressure to drop and for them to become dizzy and even disoriented. Such a condition, known as postural hypotension, is a common cause of falls. It often is caused, or worsened, by dehydration and medications. Aside from drinking fluids and exploring reduced medication intake, remedies also may include elastic stockings, abdominal binders, and other medications. "Your blood pressure needs to be checked in two positions," Brangman says. "It's real important that we know what your blood pressure is when you're standing up" although many physicians' offices take blood pressure readings only when a patient is seated.

Vitamin D. "Older persons with suspected vitamin D deficiency should be routinely offered supplementation to reduce fall risk," the guidelines say. "Vitamin D supplementation at appropriate levels should also be considered for all older adults." Brangman adds that people living in the Northeast and other areas with low seasonal sunlight levels should be evaluated for vitamin D deficiency.

Feet and footwear. Common sense rules the day when it comes to aging feet. Well-fitting, comfortable shoes with nonskid soles are recommended. Also, Brangman says seniors who use canes should regularly make sure the rubber tip on the cane is not worn down.

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Age-friendly homes. Many falls and other senior accidents occur at home and can be avoided with a bit of prevention. Many local agencies on aging and other senior programs can recommend or provide home-screening services to identify problems. They also may have recommended service companies to address needed modifications. "I would go through the house and declutter it," Brangman says. "That can be a big issue among adults who grew up in the Depression. They are reluctant to get rid of things."

"If you do fall, be sure to talk about it with your doctor," Brangman advises. "So many people are reluctant to tell their doctors if they have a fall. They're often afraid it will be the first step toward making them go into a nursing home. But there are so many interventions that could be done to prevent another fall."

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