Fall prevention
5486225
206940314
2008-04-20T19:25:33Z
207.178.98.26
/* Fall prevention interventions */ ~~~~
'''Fall prevention''' is a variety of actions to help reduce the number of accidental [[falling|falls]] suffered by older people.
Falls and fall related [[injuries]] are among the most serious and common medical problems experienced by [[elderly|older adults]]. Nearly one-third of older persons fall each year, and half of them fall more than once.<ref name="Moylan2007">Moylan KC, Binder EF. Falls in older adults: risk assessment, management and prevention. ''Am J Med''. 2007;120(6):493.e1-6. PMID 17524747</ref> Because of underlying [[osteoporosis]] and decreased mobility and [[reflexes]], falls often result in [[hip fracture]]s and other fractures, [[head injury|head injuries]] and even [[death]] in older adults. [[Accidental injury|Accidental injuries]] are the fifth most common cause of death in older adults.<ref name="Moylan2007"/> In around 75% of hip fracture patients, recovery is incomplete and overall health deteriorates.<ref name="Moylan2007"/>
The most consistently proven predictors of fall risk are history of a fall during the past year and [[gait]] and [[balance]] abnormalities.<ref name="JAMA2007">Ganz DA, Bao Y, Shekelle PG, Rubenstein LZ. Will my patient fall? JAMA. 2007;297(1):77-86. PMID 17200478</ref> Some studies (but not others) indicated that [[Visual impairment|impaired vision]], certain [[medications]] (especially [[psychotropic drugs]])<ref name="drugs">Hartikainen S, Lönnroos E, Louhivuori K. Medication as a risk factor for falls: critical systematic review. ''J Gerontol A Biol Sci Med Sci''. 2007;62(10):1172-81. PMID 17921433</ref>, decreased [[activities of daily living]] and impaired cognition are associated with a higher risk of falls. The contribution of [[orthostatic hypotension]] to fall risk remains uncertain.<ref name="JAMA2007"/>
== Fall Prevention Strategies and Interventions ==
Research indicates that multifactorial intervention programs can reduce the number of falls; in a [[meta-analysis]] of studies of older people in general the reduction was around 27%, and in those selected because of a previous fall or other risk factor there was a 14% reduction.<ref name="Cochrane2003">Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH. Interventions for preventing falls in elderly people. Cochrane Database Syst Rev. 2003;(4):CD000340. [http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000340/frame.html Full text]</ref> Although further research is needed, preventative measures with the greatest likelihood of a positive effect include strength and balance training, home [[risk assessment]], withdrawing [[psychoactive drugs|psychotropic medication]], [[cardiac pacing]] for those with [[carotid sinus hypersensitivity]], [[Tai chi chuan|Tai Chi]].<ref name="Cochrane2003"/> Tai Chi exercises have been shown to provide 47% reduction in falls in some studies but it does not improve measures of postural stability. Tai chi may gain its success, in part, from promoting confidence rather than primarily reducing the postural instability.[http://www.ptjournal.org/cgi/content/abstract/77/4/371]
== Altering Eyeglass Selection and Usage ==
Bi-focal and tri-focal eyeglasses are commonly ground to provide refractory correction ideal for reading, that is, 12 to 24 inches, when the wearer is looking downward through them. These glasses, used for reading, are therefore not ideal for safe walking, where correction for 4 1/2 to 5 feet would be far more appropriate. Some countries with universal health care recommend separate reading and walking glasses, a rather rare practice in the U.S. in the early 21st Century.
=== Medical management (risk assessment and follow-up) ===
The aim of medical management is to identify factors that can contribute to falls and fracture risk such as osteoporosis, multiple medications, [[Equilibrioception|balance]] and [[Gait (human)|gait]] problems, loss of [[Visual perception|vision]] and a history of falls. BEERS LIST is a list of medications that are potentially inappropriate for use in the elderly and some of them increase the risk of falls [http://mqa.dhs.state.tx.us/qmweb/MedSim/MedSimTable1.htm].
Assessment of every fall should be aimed at identifying the inciting cause so that it can be avoided in future. If the fall is clearly without loss of consciousness, a "Get up and Go" test should be performed to assess the mobility and a thorough examination of musculoskeletal system should be performed to identify any contributory factors.
=== Balance and strength ===
Studies show that balance, flexibility, and strength training not only improve mobility but also reduce the risk of falling. The majority of older adults do not exercise regularly and 35% of people over the age of 65 do not participate in any leisurely physical activities. Many people who have already fallen simply stop exercising for fear of falling again.{{Fact|date=February 2008}}
=== Environmental modification ===
The home environment can present many hazards. Common places for injurious falls are the [[bathtub]] and [[Stairway|steps]]. Changes to the home environment are aimed at reducing hazards and help support a person in daily activities. Changes could include minimizing clutter, installing grab bars in the shower or tub or near the toilet, and installing non-slip decals to slippery surfaces.<ref name="Nonpharmaco2008">Lin JT, Lane JM. Nonpharmacologic management of osteoporosis to minimize fracture risk. ''Nat Clin Pract Rheumatol''. 2008;4(1):20-5. PMID 18172445</ref> Stairs can be improved by providing handrails on both sides, improving lighting, and adding color contrast between steps. Currently, there is insufficient scientific evidence to ensure the effectiveness of modification of the home environment to reduce injuries.<ref name="Cochrane2007">Lyons RA, John A, Brophy S, ''et al''. Modification of the home environment for the reduction of injuries. ''Cochrane Database Syst Rev''. 2006;(4):CD003600. [http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003600/frame.html Full text]</ref> It appears that changes to the environment are not easily implemented because of low uptake by study participants.<ref name="Cochrane2007"/>
== See also ==
*[[Home Modifications]]
*[[Home automation for the elderly and disabled]]
*[[Assisted living]]
*[[Lord, Stephen R., et al. Falls in Older People: Risk Factors and Strategies for Prevention]]
==References==
<references/>
==External links==
*[http://www.profane.eu.org ProFaNE - Prevention of Falls Network Europe]
*[http://www.stopfalls.org/ Fall Prevention Center of Excellence] FPCE Program Office housed at the University of Southern California
[[Category:Injuries]]
[[Category:Geriatrics]]
[[Category:Patient safety]]