Reducing elderly falls by reducing risk factors

Betty's ideas about falling were typical of many older adults. She didn't see herself as being at risk...

Betty fell and broke her wrist last year, and this summer she fell two more times. Her concerned daughter gave her a leaflet on preventing falls. Betty didn’t read it, but she did pass it on to her older neighbour, Margo. Betty had noticed that Margo was unsteady on her feet.

Betty’s ideas about falling were typical of many older adults.

She didn’t see herself as being at risk. When asked about the cause of her falls, she stated that she was not paying enough attention. Although this was true, it was only part of the story.

According to dozens of national and international studies, most falls have more than one cause, and each person has a unique collection of risk factors that may add up to a fall. Reduce the number of risks to reduce the chance of falling.

The American and British Geriatric Societies recommend that any senior with two or more falls in the past year, or with walking and balance problems, should have their fall risks assessed and eliminated or at least reduced.

Medical status and medications are the first group of modifiable fall risks. Good management of acute and chronic health conditions, together with yearly review of medications, help prevent falls.

When Betty and her family doctor next met, they discovered that Betty’s medications caused her blood pressure to drop too low when she stood up quickly. The doctor adjusted her dose of blood pressure pills, and Betty’s occasional feeling of light-headedness vanished.

An annual vision test is also recommended for all seniors. In Betty’s case, an updated eyeglass prescription improved her ability to see uneven ground and cracks in the pavement.

Behaviours such as personal routines and lifestyle choices have a powerful effect on fall risk. Low levels of exercise, loose or high-heeled footwear, too much alcohol, poor eating habits, dehydration, social isolation, poor use of walking aids, and risky behaviours such as hurrying or climbing ladders, all increase the chance of falling.

The good news about these behavioural risk factors is that they are modifiable, provided that the person is ready and willing to change.

In Betty’s case, she admitted to being quite sedentary, and recognized that she would not exercise on her own. Her strategy was to partner with her neighbour Margo for daily walks and a twice-weekly fitness class. A wise choice, as muscle weakness is one of the key risks for falls.

Environmental hazards are a third group of modifiable fall risks.

Betty’s falls had all happened inside her home, which is the case for the majority of seniors’ falls. She and her daughter used the home safety checklist on the website to evaluate her apartment for hazards that might cause her to trip, slip, or fall.

Common hazards include clutter, loose carpets, poor lighting, trailing electrical cords, slippery or uneven surfaces, chaotic environments, furniture that is too low or unsteady, difficult-to-reach cupboards, and structures in poor repair.

Falls can be prevented. First, identify the fall risks for each person. Then, make a customized plan that will modify or correct the fall risks.

There are a number of local programs and agencies that provide fall prevention information and training. Look for a list of local resources in the next column about fall prevention.

Guest columnist Dale Graham is a registered physiotherapist with a special interest in research and treatment for fall prevention. She is certified as a FallProof Balance and Mobility Specialist and is an online instructor for the Canadian Fall Prevention Curriculum.