Falls and Risk Factors for Falls in the Older Adult

Page By: Christina Mondrian

Topics in Geriatrics: Falls and Risk Factors for Falls in the Older Adult

Falls are the leading cause of accidental mortality and injury in adults over 65 years of age (Bergen, Stevens, & Burns, 2016). The expense for all fall related accidents is expected to exceed 67 billion dollars by the year 2020 (www.ncoa.org). Falls also have a large impact in the quality of life of these patients which can lead to increased fear of falling, depression, isolation, and decreased activity which leads to an increase in health deterioration. It is important to know the identify risk factors for falls so that early interventions can be started. Early intervention has been has a higher success rate of preventing falls.

Objectives:

1.    Learn the risk factors for falls in the older adult.

2.    Learn interventions to prevent falls in the older adult.

3.    Learn about the evidence related to fall prevention in the older adult.

Falls are typically experienced due to a combination of risk factors. The more risk factors a person has, the more likely they are to experience a fall. It is important for health professionals to help identify and decrease the number of risk factors a patient has in order to prevent future falls.

RISK FACTORS-

Gait & Balance: Impaired gait and balance is a primary link to falls. Some effective gait and balance screens include: STEADI, TUG, Single Limb Stance, DGI, FGA. See below for resources to these test measures.

Vision: poor vision, macular degeneration, glaucoma, cataracts

Strength: muscle weakness

Medications: side effects of medications can include dizziness, confusion, hypotension, lethargy, poly-pharmacy is linked to higher risk

General Health: chronic conditions such as diabetes, arthritis, stroke, Parkinson’s, multiple sclerosis, cognitive impairment, heart disease, cardiovascular impairments, incontinence, osteoporosis

Environmental Hazards: poor stair design or lack of railings, tripping hazards such as area rugs or electrical cords, uneven surfaces, dim light, lack of bathroom grab bars

INTERVENTIONS-

Gait & Balance: Implement walking program with assistive device or footwear modifications necessary. Discuss access to local tai chi or yoga classes with patient.

Vision & Hearing: Have an annual vision and hearing exam. Always wear prescription glasses, contacts, or hearing aids.

Strength:  Develop a specific exercise program tailored to any deficits the patient may have. Focus on maintaining or developing muscle strength, bone mass, and joint/tendon flexibility.

Medications:  Check current medications for compliance, necessity, and any interactions.

General Health: Annual physical exams are important to discuss existing conditions and identify any changes in health.

Environmental Hazards: Have a home evaluation to identify any hazards in the home and implement solutions.

Additional Resources for Information:

1. National Council on Aging: 2. The Mayo Clinic: 3. World Health Organization: 4. Centers for Disease Control and Prevention: 5. Balance Tests:
 * https://www.ncoa.org/healthy-aging/falls-prevention/
 * https://www.mayoclinic.org/healthy-lifestyle/healthy-aging/in-depth/fall-prevention/art-20047358
 * http://www.who.int/ageing/projects/EMRO.pdf
 * http://www.who.int/ageing/projects/EMRO.pdf
 * http://geriatrictoolkit.missouri.edu/balance/index.htm

References 

1.Lord SR, Sherrington C, Menz HB, Close JCT.Medical management of older people at risk of falls. Falls in Older People.:240-263.

2. Bergen G, Stevens MR,Burns ER. Falls and Fall Injuries Among Adults Aged ≥65 Years — United States,2014. MMWR Morbidity and Mortality Weekly Report. 2016;65(37):993-998.

3. Davis K. Vision and falls:a multidisciplinary review of the contributions of visual impairment to falls among older adults. Primary Health Care. 2014;24(7):16-16.

4. Guirguis-Blake JM, Michael YL, Perdue LA, Coppola EL, Beil TL. Interventions to Prevent Falls in Older Adults. Jama. 2018;319(16):1705.

5. Lee A. Preventing Falls in the Geriatric Population. The Permanente Journal. February 2013:37-39.

https://www.ncoa.org/search-results/?q=falls