Understanding and Preventing Falls

By Stephanie Thompson, R.N.

June is National safety awareness month. The safety topic we are going to discuss is falls.

Falls are common and oftenFall1a devastating problem among older people, causing morbidity, mortality and can cause premature nursing home admissions. Some of the identifiable risks that are associated with falls are weakness, unsteady gait, confusion, and certain medications. Unintentional injuries are the fifth leading cause of death in older adults.   Identifying at-risk patients is the most important part of management.

To understand falls, one must understand the prerequisites for a normal gait. Among these are neural networks in the brain stem, musculoskeletal structures with regulated muscle tone, and proper processing of sensory information. Effective coordination of all of these components, along with adequate cognition and concentration is needed to prevent fall and maintain gait.

It is not surprising that many of these functions show at least some decline with aging and increase the risk of falls. Many changes occur with aging , such as decrease in step length and decrease in lower limb strength. Accumulating medical problems and side effects of medications to treat those problems also put one at a higher fall risk.

Medications are a well established risk factor for falls. It is important to consider the reason for taking a medication before deciding to stop it for the purpose of fall prevention because the condition the drug is used to treat might itself be a risk factor for falling. Each medication should be examined individually.

Some medication classes that have been associated with an increase risk of falls include:

  • Antihypertensive agents
  • Sedatives and hypnotics
  • Neuroleptics and antipsychotics
  • Antidepressants
  • Benzodiazepines
  • Non steroidal anti-inflammatory drugs

Various interventions have been shown to decrease the risk and rate of falls. Some of these are:

  • Vitamin D- this supplement has been shown if given in doses of 800IU or more to decrease falls
  • Exercise-programs focusing especially on balance exercises have been shown to decrease falls
  • Medications-gradual reduction of psychotropic medication reduces the rate of falls. This should be done carefully and your physician should be consulted.
  • Vision-Visual impairment is one important risk factor. Annual eye exams and cataract removal have reduced falls
  • Environment- avoiding clutter, wearing foot wear that fits correctly, using assistive devices as needed, uneven surfaces are also good interventions for reducing falls

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