One Fall (Autumn) is inevitable every year, but the second type of fall does not have to be inevitable. Consequences of the second type of fall for any age group can be severe, even life changing. Seniors, however, are particularly vulnerable to falls. In fact, falls are a leading cause of injury for people over the age of 65, and a contributing factor for accidental death in this age group. It is reported that one third of people over 65, fall yearly. Within this group, 50% of these falls represent recurrent events.
When we think of falls, we commonly associate fractures as the main injury sustained from a fall. This may be true for a younger person who fractures an arm, for example. However, in the 65 and older age group falls can lead to permanent disability, depression, social isolation, and a big hit to financial stability.
Why are Senior Citizens more vulnerable to falls?
Walking and staying vertical, in simple terms involve a brain that is inputting and responding to environmental stimuli (Oops there’s a curb ahead) a neurologic network that communicates to your muscles (Hey thigh muscles and calves stop walking) and muscles that can respond to the command to stop walking. The individual in this instance must be able to see the curb, hear the traffic, interpret it as dangerous, and accomplish the task of pausing at the curb. This integrated response is coordinated in a complex way.
Let’s consider the different vulnerabilities for a fall:
Cognition and Concentration: Impairment of these abilities, are often due to neurologic conditions such as stroke, brain injury, including tumors, dementia from multiple causes, and fluid buildup in the brain known as hydrocephalus. Depression and other psychologic diagnoses can also affect cognition. Environmental factors such as extreme heat, or excessive cold or lack of oxygen can affect cognition. Loss of vision and hearing can prevent the brain from recognizing appropriate stimuli and this loss of cognition can contribute to falls.
Neurologic diseases can affect gait and Examples are Parkinson’s disease, and Epilepsy, or any seizure disorder.
Musculoskeletal diseases can interfere with muscle strength and Examples are any condition that affects joints, any condition that causes chronic pain, resulting in impaired gait and posture.
Sensory loss from any condition can contribute to vision loss, hearing loss and loss of proprioception (unconscious ability to sense movement, action, or the position/location of your body). An example of a common medical condition that can cause sensory loss in the feet is diabetes. Foot deformities that cause pain such a bunion can also affect gait.
Medications, be they prescription or over the counter, can contribute to a potential fall. Medications can cause dizziness, sedation, confusion, and change in bowel Always read the side effect warnings of all medications you take.
Finally, regardless of how healthy you are, aging in of itself contributes to fall risk. Gait changes occur with aging. Bone density decreases with aging, which is an added risk factor for a fracture associated with falls. Balance declines with aging. Associated side effects of medications can increase as the daily doses of medications increase. Blood pressure decreases rapidly with the act of standing up, known as postural hypo-tension, can cause dizziness, and is more common as we age and can cause falls.
Thus far, this discussion may have been informative, but it is certainly not uplifting (no pun intended). The good news, however, is that fall prevention is a front and center goal of multiple national agencies. The medical community which includes but is not limited to physicians and nurses and occupational and physical therapist, has heightened sensitivity to finding solutions to minimize fall risk. Exercise classes for seniors geared to increase strength and endurance are available in most communities. Tai Chi has been reported to be the single best program for fall prevention. Other national agencies have studied how to increase safety in our homes to prevent falls.
What are environmental factors associated with falling?
Environmental assessments for fall prevention in the home stresses maximizing safety, which includes preventing falls. As the homeowner’s needs change, changes to the physical environment can make a difference allowing the resident to continue to live safely at home. It is noted that approximately 28 % of all falls occur at home. An additional 25% of falls occur on curbs and sidewalks just outside of the home.
- Slippery surfaces: Showers, bathroom floors when wet,
- Throw rugs, non-tacked down carpet, worn out rugs, uneven
- Clutter is a big contributor to tripping and falling. Walkways indoor the home as well as outdoor walkways leading to home entrances should be clutter
- Electrical cords should not be crossing the floor and should be secured.
- Stairs: Safety assessment for stairs include stability and sturdiness of the actual steps, presence of railings that are firmly in place, as well as good lighting for the entire length of the stairway.
- Reaching for things that are not within reach. Avoid standing on an unstable surface, such as a folding A step stool should have a safety bar, and a wide base.
- Evaluate all the rooms of the house for safety: Are there lamps within reach at bedside? Is there a night light? Is there a flashlight
- Bathroom: Nonslip strips in the tub, grab bars for tub and shower and for getting off toilet. High toilet seats can ease ability to rise from toilet seat.
- Be willing to rethink the layout for the home: For example, If the bedroom is upstairs, perhaps it is time to move into a downstairs room. Be willing to rearrange furniture so that tripping or bumping into furniture is not a risk.
- Know where your pets are when you are changing positions are walking within the home to avoid tripping over your pet.
- Address sensory deficits such as decreased hearing or Have a hearing test and use your hearing aid. Keep your glasses prescription up to date.
- Pay attention to footwear: Shoes should fit Consider Velcro rather than shoelaces
What services are available in accomplishing the evaluation to provide a safe home?
Programs that address fall prevention should include medical evaluation and recommendations, fitness evaluations and recommendations as well as home assessment for safety. A “one size fits all “program” may be available in some communities. In other communities networking for Fall prevention may involve a medical consult, a referral to a home health agency for coordination of delivery of medical recommendations and home assessments. Seniors with concerns about falls can enter the evaluation and enactment of recommendations at any point in this dynamic. For example, a Physical or Occupational Therapy referral for an injury may prompt an evaluation for home safety, or a recommendation for group or home exercises for improving strength, along with a recommendation for assessment for home safety.
In closing, remember these basic elements to keep you from falling: “V.E.R.N.”
Vision: Have your eyes checked regularly.
Exercise: Have a regular exercise program based on your own abilities.
Review: Review your daily medications with your doctor as it refers reducing falls.
Now: It’s time to ensure your safety. Remove clutter and trip hazards.