Fall prevention

Falls are a major threat to the health and independence of older adults, people aged 65 and older. Each year in the United States, nearly one-third of older adults experience a fall.

Approximately one out of ten falls among older adults result in a serious injury, such as a hip fracture or head injury, that requires hospitalization. In addition to the physical and emotional pain, many people need to spend at least a year recovering in a long-term care facility. Some never return to their homes. Falls are the leading cause of injury deaths among older adults.

In King County, there were 9,268 EMS responses to older adults who had experienced a fall in 2008. Each year, a substantial amount of EMS resources are dedicated to responses due to falls among older adults. Over 17.4% of EMS responses to patients aged 65 and over are attributed to falls. In King County there are more accidental deaths each year among older adults 65 and older attributed to falls than there are deaths attributed to motor vehicle accidents among the same group.

Who is at risk?

• Men are more likely to die from a fall. After adjusting for age, the fall fatality rate in 2004 was 49% higher for men than for women (CDC 2005).
• Women are 67% more likely than men to have a nonfatal fall injury (CDC 2006).
• Rates of fall-related fractures among older adults are more than twice as high for women as for men (Stevens et al. 2005).
• The risk of being seriously injured in a fall increases with age. In 2001, the rates of fall injuries for adults 85 and older were four to five times that of adults 65 to 74 (Stevens et al. 2005)
• Nearly 85% of deaths from falls in 2004 were among people 75 and older (CDC 2006).

There are four important strategies that can reduce your risk for falls:

• Exercise
• Home modification checklist
• Safe use of medication
• Vision

Keeping in good physical condition with moderate daily exercise will reduce your risk of falls. A combination of flexibility, weight bearing exercises and aerobic exercise can markedly improve your level of fitness-at any age. Even if you should fall, being in good physical condition will lower your chances of serious injury and raise your ability to heel quickly and completely. You should always talk to your healthcare provider about what kinds of exercise are best for you and about specific exercise instructions.

Regular exercise can:

• Improve your muscle tone, strength and endurance
• Keep joints, tendons and ligaments more flexible for unrestricted movement
• Increase your sense of balance, agility and confidence
• Strengthen your bones to fight osteoporosis and resist injury
• Increase your stamina and energy

Different types of exercise:

• Physical therapists can teach people how to compensate for balance problems and determine if your walking could be steadied with either an exercise program to strengthen muscles, or an assistive device such as a cane or walker.
• Community programs such as: Tai Chi, Enhanced Fitness, Matter of Balance, group exercise programs, individual exercise sessions can provide strength, balance and flexibility.
• Personal trainers can provide one on one exercise programs in your home or at fitness centers.

Certain disorders like arthritis or strokes may inhibit movement and prevent a senior from responding rapidly to avert a fall. Quick motions can also affect the inner ear and cause dizziness, so it's important to allow time to adjust for balance when getting up from a sitting or lying position.

Approximately 50%-70% of falls are due to home hazards, so it's crucial to recognize risks before they lead to an accident. The following checklist will help you identify common hazards that lead to falls.

Lighting

Floors

Steps and stairways

Living room, bedroom and kitchen

Bathrooms

Shoes

Four out of five older adults take at least one prescription medication per day and most take at least 2 prescriptions a day. Drug interactions and the physical changes that come with age can lead to an increased risk of falling. While all drugs should be administered carefully, certain medicines are more likely to involve risk of falling then others, such as those affecting the central nervous and cardiovascular systems. The more medications are taken, the greater risk of risk of drug interactions and side effects. Symptoms can range from dizziness to drowsiness, vision impairment and loss of balance.

Tips to manage your medication safely:

• Keep a complete and updated medication list, including prescriptions, over-the counter medications, herbs, and vitamins, and always carry it with you.
  
  
• Bring your medication list every time you visit the doctor or hospital.
  
  
• Have all your medications filled at one pharmacy. All pharmacies have a computer system that can detect potential drug interactions.
  
  
• Ask your pharmacist or your doctor about drug interactions ("Will this medication interfere with my other medications?").
  
  
• Take your medications regularly, don't skip or decrease the dose to cut cost.
  
  
• Avoid over-the-counter sleeping aids, allergy medications and antihistamines in over-the-counter cough and cold products. Talk to your doctor or pharmacist for a better and safer alternative.
  
  
• If you see a specialist, make sure your specialist sends reports to your primary care doctor. Also tell your primary care doctor if other doctors have changed your medications.
  
  
• Always ask your doctor before you start an herbal supplement or over-the counter remedy and don't forget to ask your pharmacist to check for herb-drug interactions.
  
  
• Report adverse drug reactions to your doctor.
  
  
• Ask your pharmacist if your medications look different in any way (color, size, shape) than the ones you're currently taking.
  
  
• Limit use of alcohol
  
  
• Never use someone else's medications and discard old unused medications.

Eye disease or normal aging can make it difficult for seniors to read fine print, judge distance or identify objects clearly. These factors can lead them to develop a poor sense of balance or misread medicinal instructions. Have your vision checked annually and prescriptions updated as needed.

The three most common eye conditions in older adults are cataracts, glaucoma and macular degeneration. All of these conditions can develop slowly and gradually without symptoms until vision is impaired.

• A cataract is the thickening of the eye lens due to aging which causes gradual sight loss.
• Glaucoma is an increase in pressure inside the eye that causes gradual sight loss.
• Macular degeneration is the gradual loss of central vision.

Reduced depth perception due to bifocals, reading glasses, low lighting, and some eye conditions can cause falls. Reduced depth perception makes it difficult to accurately judge walkway changes like curbs, steps, and uneven ground, and can affect driving skills. In addition, a loss of depth perception makes it difficult to see objects in areas of shadow, low lighting, nighttime darkness, or excessive brightness.