One second, that is all it takes for an elderly individual to fall and suffer a serious injury. However, it may take months or even years for that person to recuperate. Falls in the elderly are of particular concern because of the physical, psychological, and financial consequences that result from a fall. Examining both the intrinsic and extrinsic risk factors associated with falls in the elderly can significantly reduce the number of falls. Prevention and treatment of falls can be best addressed by a multidisciplinary team approach. An effective plan for preventing falls requires not only the efforts of a professional team, but also committed efforts on the part of the individual and their family.
The injured elderly comprise an ever-increasing proportion of our population and they are largely responsible for the escalation of health care costs. The elderly, most of whom live on a limited, fixed income often depend on their health insurance coverage to provide for the strengthening exercises and balance therapy need to reduce their risk of falling. Unfortunately, with the tight constraints on managed health care today, these services are often limited. Limitations on preventative therapies will undoubtedly increase the risk of falling by the elderly who experience the multiple neuromuscular changes that occur with aging.
Why the Elderly are at Increased Risk
The significant number of falls in the elderly can be attributed to the changes that occur in the human body with aging. Aging is associated with multiple neuromuscular changes difficult to distinguish from disease. Both aging and arthritis result in progressive degeneration of mechanoreceptors in large joints, thus impairing patients’ perceptions of their position in space. This may lead to a sensation of dizziness or instability and result in falling when a patient is confronted with an environmental hazard (Lipsitz, 1996). The magnitude of the problem associated with falls in the elderly can be best appreciated when one considers that nearly one-third of people over age 65, residing at home, fall each year (Winslow, 1998). Approximately, 10,000 deaths each year are related to falls in the elderly and that statistic is expected to rise significantly throughout the next generation because the elderly are living much longer (Grabowski, 1998).
Falls are a Growing Problem due to a Growing Elderly Population
The importance of understanding the physical changes associated with aging has become apparent to health care workers as they care for an ever-expanding elderly population. By the year 2000, there will be 36.3 million Americans, or 13.2% of the population, over age 65 (Burke & Sherman, 1993). Now consider that approximately one-fourth to one-third of community-dwelling people older than 65 years, and up to one-half of institutionalized elderly, fall at least once a year (Anonymous, Falling down, paragraph #1). This significant number of falls in the growing elderly population has resulted in astronomical health care expenses for our country. According to the national accident statistics, 200,000 people 65 or older suffer hip injuries as a result of falls (Anonymous, Elderly and falls, paragraph #3). Hip fracture care, which averages $35,000 per patient, accounts for a large portion of the $20 billion a year health care cost associated with falls in the aged population (Anonymous, 1998, The public’s health).
Although hip fractures are commonly associated with falls in the elderly, other physical injuries include soft tissue damage, other bone fractures, internal hemorrhage, aspiration pneumonia, dehydration, and death. An estimated one percent of falls result in hip fractures; three to five percent result in other types of fractures, and an additional five percent produce serious soft tissue injuries (Anonymous, Help the elderly cope with falls, paragraph # 4). The mortality rate for patients with hip fractures is 15 to 20 percent higher than the mortality rate in those who have not had a fracture. Over one-third of these deaths occur among persons older than 85 years of age. Falls are also an important marker of mortality (Anonymous, Help the elderly cope with falls, paragraph # 4). Of patients who are hospitalized for a fall, only about one-half are alive a year later; however, this rate reflects the seriousness of underlying illness and frailty and not the fall itself (Steinweg, 1997).
Psychological Effects of a Fall on the Elderly
In addition to the multitude of physical effects resulting from a fall, elderly patients are also exposed to a variety of psychological stresses after experiencing a fall. Many frail elderly persons consider a fall the beginning of the end, the boundary between independence and dependence or death. Some elderly persons develop symptoms or behaviors in response to a fall, regardless of physical trauma. They may develop an increased fear of falling that could result in detrimental emotional, psychological, or social changes (Vellas, Wayne, Romero, Baumgartner, & Garry, 1997). Falls and the resulting injuries can have a dramatic impact on self-confidence and independence, often leading to decreased mobility, increased debility, and diminished quality of life. The loss of self-esteem and the fear of repeated falls are psychologically damaging to the elderly (Di Domenico & Ziegler, 1994, p. 177). One of the major consequences of fear of falling is activity restriction, which is itself a risk factor for falls because it can lead to muscle atrophy or deconditioning and, ultimately, reduced health and physical functioning. Fear of falling also can compromise quality of life by limiting social contacts or leisure activities (Lachman, Howland, Tennstedt, Jette, et al., 1998). Some degree of fear of falling may, however, be adaptive if it leads to increased caution. In its extreme forms, however, fear of falling becomes immobilizing or creates debilitating anxiety that distracts focus from or interferes with an activity.
Risk Factors Contributing to a Fall
In an effort to minimize the devastating physical and psychological effects of falls, the intrinsic (host) and extrinsic (environmental) factors precipitating falls must be addressed. Aging results in natural changes in the human body, as discussed earlier, but there are additional risk factors that can be prevented and/or managed effectively. Lach, et al. found that intrinsic risk factors such as dizziness, weakness, difficulty walking, and confusion account for 45% of falls in community-dwelling elders, whereas slippery surfaces, loose rugs, loose objects, or poor lighting accounted for 39% of falls in this population (Guccione, 1993).
Intrinsic Risk Factors
Osteoporosis. As people grow older, it is inevitable that they develop some degree of osteoporosis, a condition in which increasing bone porosity results in the development of fragile bones. Osteoporosis is seen most often in women which contributes to the fact that women fall twice as often as men (Smith, 1993, paragraph #2). Osteoporosis, however, is just one of the many causes contributing to falls in the elderly. Other risk factors include:
Poor Vision. Eyesight deteriorates with age, and as a result many elderly develop cataracts, glaucoma, macular degeneration, and night blindness. Cataracts cause the lens to lose its transparency and therefore blurred vision and problems with glare can develop. Glaucoma can cause loss of peripheral vision, while macular degeneration causes central vision to deteriorate. Night blindness, or poor dark adaptation causes the elderly person to experience semi-blindness when going from lighted areas into the dark (Walker, 1998).
Loss of muscle strength and flexibility. Muscle strength decreases sharply by the time a person reaches age 80. For instance, older people with a poor handgrip have more trouble holding onto railings. Weakened arm muscles make it difficult to push themselves up from a chair, and weak legs make it difficult to get up from a chair. Loss of flexibility, often the result of osteoarthritis, seems to go hand in hand with diminished muscle strength. Even the generalized arthritic pain frequently experienced by the aged population, can lead to decreased activity, creating a vicious cycle that leads to ever-greater loss of strength and flexibility (Walker, 1998).
Poor mobility. A person’s mobility depends on his gait, posture, and balance. Age related changes in all three can contribute to falls. Many older people do not swing their arms as freely and do not lift their feet as high, often as a result of stiff joints and weak muscles. As people age, they develop changes in their gait. They begin taking shorter, slower strides which impede their mobility, making it difficult for them to adapt to sudden changes in their environments (Webb, The public's health, paragraph #3). The elderly, who are less likely to exercise regularly, frequently develop muscle weakness associated with poor posture. Elderly inactivity often leads to weight gain which affects their centers of gravity and ultimately results in poor balance (Walker, 1998). Gait, posture, and balance are all contributing factors for falls, however, if an elderly person regularly exercises, his/her risk will be significantly reduced.
Acute and chronic disease. Several other diseases besides osteoarthritis can make elderly individuals prone to falls. Cardiovascular disorders, disorders associated with dizziness and syncope, and cerebrovascular accidents (strokes) all render a patient more likely to fall. Patients with Parkinson’s disease, for example, have trouble maintaining an upright posture and in order to preserve their balance, they usually stoop, lean forward, and develop a short-stepped gait, and begin to shuffle. All these compensations increase the Parkinson patient’s risk of falling. Peripheral neuropathy, associated with diabetes, decreases sensation in the legs and feet which can lead to falls (Di Domenico & Ziegler, 1994).
Polypharmacy and alcohol. It has been estimated that people over the age of 65 comprise 11 - 12% of the population but consume 30% of the medications. In 1994/95, 13% of Canadians aged 75 and older reported that they had taken five or more drugs during the two days before their interview for the National Population Health Survey (Anonymous, The rule of five, paragraph #3). The use of four or more medications increases the risk for falls and increases the risk of cognitive impairment nine-fold as a result of adverse drug reaction (Anonymous, Falls and the elderly, paragraph #1). Three groups of medications that are of particular concern include sedatives and hypnotics, tranquilizers, and antihypertensive drugs. Elderly persons taking tranquilizers with a long half-life, for example, are 70% more likely to fracture hips than older persons not taking psychotropic drugs (Funk, Torquist, Champagne, & Weise 1992). With this in mind, any patient who is taking sedatives or psychotropic drugs should be considered at risk for falling. Diuretics and laxatives have also been linked to falls because they increase trips to the bathroom, and each hurried trip creates the potential for stumbling (Walker, 1998). Alcohol often contributes to fall-related injuries in the elderly. Any older person who takes medications and consumes any amount of alcohol is at increased risk for falling. At least 100 prescription drugs can interact with alcohol, including tranquilizers, hypnotics, and antihypertensive agents (Walker, 1998).
Dementia. Studies often find that patients with dementia - especially Alzheimer’s disease - are at greater risk for falling than other older adults (Walker, 1998). This increased risk is associated with their impaired cognitive status and lack of realization of conceivably dangerous situations. Alzheimer’s patients frequently wander about, often finding themselves in potentially dangerous environments.
Fear of falling. Most older people are aware of the complications of a serious fall and this can instill a morbid fear of falling. Fear of falling can so immobilize some patients that they become clinically depressed. Depression can shorten the individual's attention span therefore increasing his/her risk for falling (Walker, 1998).
Poor nutritional status. The incidence of falls has also been linked to poor nutritional status. Decreased calcium and vitamin D may increase the risk of fracture in patients with osteoporosis. Decreased vitamin D intake has been associated with poor muscle tone and vitamin B-12 deficiency can lead to diminished proprioception (Anonymous, Get up and go, paragraph #4).
Prevention of Intrinsic Risk Factors
Prevention of intrinsic risk factors involves the services of a number of professional team members. A multidisciplinary team approach is most effective when the patient is compliant. However, many intrinsic factors are not preventable and the risk associated with them can be reduced with the assistance of numerous health care professionals in an attempt to prevent future falls.
The assistance of an optometrist and/or opthamologist can correct or modify many vision problems that pose as risk factors for falls in the elderly population. The individual should schedule regular eye exams and wear the correct prescription lenses prescribed. He/she might also benefit from counseling if he/she is having difficulty adjusting to bifocals and trifocals (Felsenthal & Garrison, 1994).
The assistive devices and exercise programs recommended by the physical therapist are helpful in preventing falls related to poor mobility. Patients with balance problems, who are at an exceptionally high risk of falling, may be prescribed assistive devices such as canes or walkers. The physical therapist often recommends exercise programs to improve gait, posture, and balance. Aerobic exercises and strength training also focus on improving muscle strength and flexibility.
Falls related to acute and/or chronic disease require astute assessment and treatment by physicians, nurses, doctors, physical therapists, and dieticians. Careful management of cardiovascular conditions includes the proper use of medications such as antihypertensives and antiarrythmics. Implementation of a cardiac rehabilitation program is also beneficial to those elderly patients affected by coronary artery disease. Patients who have experienced a cerebrovascular accident (CVA) may use special splints and supportive devices (i.e. an AFO brace) to improve their balance. In addition, those patients whose ambulation is compromised by diabetic neuropathy will benefit from close serum glucose monitoring, better metabolic control, aerobic exercises, and a healthy diet (Grabowski, 1998).
Elderly people are prone to drug-related problems such as adverse drug reactions. For this reason, physicians should manage the use of prescription medications in the elderly, as well as monitor these patients closely for adverse drug interactions. The use of drugs falling within the classification of sedatives, tranquilizers, and psychotropic drugs should be scrutinized and patients using these drugs should be instructed to abstain from alcohol (Anonymous, The rule of five, paragraph #6). Those patients afflicted by dementia - in particular, Alzheimer’s disease - must be protected from their environment. Family members and caretakers should be instructed to remove as many hazards as possible from the elderly individual’s environment. These patients must also be closely supervised to prevent them from wandering into an unfamiliar and unsafe environment (Grabowski, 1998).
A physician and/or registered dietician best addresses poor nutrition in the elderly. Vitamin D and calcium supplements help to reduce the risk of osteoporosis, and B-12 supplements help to prevent diminished proprioception. In addition, community services such as "Meals on Wheels" may also assist the individual by providing food for those elderly who cannot prepare their own meals. Although attempts at prevention of intrinsic factors are extremely valuable, elderly individuals and health care professionals must also consider extrinsic or environmental factors as potential risks (DiDomenico & Ziegler, 1994).
Extrinsic Risk Factors
Extrinsic risk factors are those related to the environmental conditions. These conditions are best addressed by the individual, his/her family, and/or caregivers. Most injuries from falls occur in the home. A publication by Homesafe presents a simple three step plan to safeguard one’s home from fall hazards. The first step in safeguarding one’s home is to spot the hazard. Next, assess the risk based on the individual’s mobility and/or disability. Finally, make the necessary changes within the environment (Anonymous, Homesafe, paragraph #2). A thorough room to room modification table can be found in Appendix A.
For most falls in the elderly, however, it is difficult to distinguish between those that are intrinsically or extrinsically precipitated. Most falls are a result of the complex interaction of host and environmental factors (Guccione, 1993). If the individual takes the initiative, both host and environmental risk factors can be modified or removed, significantly reducing the likelihood of a fall.
Self-balance Hints for Older People
Another area in which the individual plays an important role in protecting himself or herself from injury lies in proper body care. According to physical therapists Carol Lewis and Doug Dillion (1995), if older people took care of their bodies by stretching and strengthening their muscles, physical therapists would not see as many clients with fractured hips and balance problems. Improving flexibility and strengthening muscle groups help to reduce the likelihood of falls because strong and flexible muscles promote balance and proper posture. A muscle that is flexible and strong will also heal faster because of the increased blood circulation in that area.
Risk Assessment for Falls/ A Multidisciplinary Approach
If attempts at prevention fail, and a fall occurs, the rehabilitation of resulting injuries requires a "continuing and comprehensive team effort" (Litsitz, 1996, p 348). The services of many professionals are needed in order to help the patient return to previous independence. These professionals include the physician, neurologist, psychologist, physical therapist, occupational therapist, social worker, and the nutritionist. Sometimes the services of an opthamologist, optometrist, orthotist, podiatrist, and speech therapist are needed (Felsenthatl & Steinberg, 1994).
Physician. The physician must obtain a thorough history in order to assist in determining the cause of the fall. His or her interview includes questions about the events and symptoms immediately preceding the fall to determine what intrinsic and extrinsic factors may have contributed to the fall. He or she should also inquire about symptoms of lightheadedness, which is suggestive of orthostatic hypotension (Steinweg, 1997). The presence of palpations may suggest an arrhythmia. Another critical question for the physician to ask is whether the patient has fallen before because the strongest predictor of falls is a previous fall. Recurrent falls are more likely to result from intrinsic risk factors which may require medical treatment. In addition to obtaining an accurate history, the physician must also perform a thorough physical examination, ordering lab tests when indicated (Steinweg, 1997).
Neurologist / Psychologist. Evaluation of the patient’s mental status is the next priority. Depending on the nature of the underlying disabling condition, the neurologist and/or psychologist may conduct screenings or more detailed testing of intelligence and cognitive functioning, perceptual skills, manual dexterity, personality and mood characteristics (i.e. depression). The critical information provided by these professionals can assist the rehabilitation team in constructing realistic goals (Guccione, 1993). For example, if a patient is having difficulty with cognitive functioning, different techniques will be utilized in the patient's treatment. If, however, the problem is depression, the patient will be prescribed certain drugs to limit the effects of the disorder. Hopefully, the drugs will modify the patient's mood and effective treatment can begin shortly thereafter (Felsenthal & Steinberg, 1994).
Physical Therapist. The physical therapist is primarily concerned with improving mobility, with a major focus on safe independence. Improving strength, range of motion, and endurance helps the patient acquire greater stability. Research has indicated that lower extremity weakness, especially at the ankle and knee, is significantly associated with recurrent falls in the elderly. It has also been established that strength gains can be made in all age groups, even in nonagenarians, by applying the physiologic exercise principles of overload and specificity (Guccione, 1993).
A visit to the patient’s home is often invaluable for focusing training on needs within that specific environment and provides an opportunity for recommendations to achieve barrier-free accessibility (Felsenthal & Steinweg, 1994). Visiting the patient's home often allows the physical therapist to spot potential hazards and remove them inexpensively. However, if the physical therapist finds environmental hazards that cannot be modified (i.e. stairs) they can equip the patient with assistive devices to reduce the likelihood of falling again.
One simple test that the physical therapist employs to evaluate balance and gait is the "get up and go" test. This test evaluates proximal muscle strength, knee and hip function, postural stability on turning, and safety in sitting (Get up and go, 1998). If the patient can not rise from a chair, walk ten feet, turn around, and sit down, a full neuromuscular evaluation is in order (Get up and go, 1998).
During my observation time in balance therapy at UPMC Lee Regional Hospital in Johnstown, Pennsylvania, I witnessed an extremely effective assessment tool being utilized. This questionnaire assisted the physical therapist in determining the need for balance therapy by including questions about the patient’s mobility status and his/her degree of concern regarding a fall. This assessment tool also included questions about intrinsic and extrinsic risk factors, as well as the use of assistive devices.
Occupational Therapy. Achieving functional independence with various self-care skills is the major focus of the occupational therapist. Occupational therapists are called upon to intervene with safety instructions and recommendations for environmental adaptations to prevent falls (Felsenthal & Stienberg, 1994). Home environment modifications often significantly improve safety and functional ability. Many times an occupational therapist will center many of the patient's daily living activities within a limited portion of his or her environment. For example, the occupational therapist may position a favorite chair near an outside view, chairside tables, television, hot plate, reading lamp, and hobby basket. In the future, many occupational therapists will be suggesting the use of personal emergency response systems (PERS), which is a device that allows a patient to push a button in their homes during an emergency event, such as a fall, in order to immediately alert medical professionals (Lachman, Howland, Tennstedt, Jette, et al., 1998).0
Social Work. The social worker is usually the principal liaison with the patient and the family and helps to establish open channels of communication with the rest of the team. The social worker insures that the rehabilitation process is continuing and coordinated beyond the hospital inpatient phase (Felsenthal & Stienberg, 1994). Often patients injured from a fall need assistance beyond the ability of the family members. Therefore, social workers enable the injured patient to gain access to services within the community such as housing, transportation, and continued nursing care.
Nutrition. If the individual’s diet is poor, they are often referred to a dietician and, therefore, some patients will benefit from nutritional supplements. In a recent study, patients over 60 years old were given a high-energy, nutrient dense supplement and they experienced a significantly lower number of falls than control patients who did not receive the supplement (Get up and go, 1998). Patients who have trouble preparing their own meals may be referred to "Meals on Wheels" or a Community Access Center by the social worker (Steinweg, 1997, paragraph #28).
Other Disciplines. Other specialists whose services may be needed include the orthotist, optometrist, the podiatrist, and/or the speech therapist. The orthotist designs special braces and shoes, often plays a role in the rehabilitation of a fallen patient (Burke & Sherman, 1993). The orthotist is faced with the challenge of effectively assessing the patient’s mobility and preventing future falls. Prescriptions for special lenses is the job of the optometrist. Elderly patients with impaired vision face a risk for falling that is two time as great as those who have had their vision modified or corrected (Grabowski, 1998). Speech and hearing services offer a unique contribution to the rehabilitation of a fallen patient. These therapists help reduce the anxieties produced from speech and hearing losses in order to lessen problems of frustration and misunderstanding. If the patient cannot communicate through speech or has severe hearing losses, they are greatly limited in their ability to recover from a fall.
Importance of Research on Falls
As we start the twenty-first century, and constraints on insurance allocations become even tighter, it is essential that each member of the multidisciplinary team prove that the work they do is beneficial. Research on falls is now focused on creative interventions to prevent falls and associated injury. Resistance exercises appear most promising for improving muscle strength and function, thus possibly reducing the incidence of falls (Lipsitz, 1996).
Undoubtedly, changes occur in skeletal muscle with "normal aging." Declines in strength have been reported for every muscle group that has been tested, averaging approximately 1% per year in the third decade of life (Guccoine, 1993). Clearly, if muscle degeneration occurs this early in life, muscle strength will continue decreasing and, therefore, have an even greater impact on the elderly population. In recent years, a number of studies documenting the positive effects of exercise for the older adult have been published. These reports overwhelming confirm the "trainability" of the older adult for endurance, strength, and flexibility (Guccione, 1993). The most significant study demonstrates that frail men and women can gain strength. Marcus Fiatarone conducted a study in which he weight-trained residents in a long-term care facilities ages 86 - 96 for eight weeks. He had these individuals perform three sets of eight repetitions of knee flexion and extension three times per week. The average strength gain at the end of eight weeks was 174% (Guccione 1993).
Another study conducted by a team of physicians, nurses, and physical therapists at Yale University involved a carefully controlled, randomized, prospective study, which used individualized multiple risk factor intervention strategies. Their approach significantly reduced the rate of falling among elderly persons living at home (Winslow, 1998). These professionals found the total cost of intervention averaged $900 per subject; a small price to pay compared to the cost of a fall with injury (Winslow, 1998).
Research studies such as these demonstrate why a large number of physicians and physical therapists demand that more governmental funds be allotted to programs aimed at keeping the elderly healthy. Indeed, federal planners, concerned about the viability of Medicare and Social Security into the twenty-first century, should recognize the significance of these studies and heed the advice of professionals who work with the elderly population.
Insurance Companies' Role in Prevention
Medicare and most insurance companies do not recognize the benefits preventative therapies provide, and they choose not to allot any significant amount of support for elderly who utilize these therapies. In a number of interviews conducted by phone with representatives from Medicare and various insurance companies, I found that little support is given to preventative exercises programs for the elderly.
When I spoke with Marcia Roller (personal communication, January, 1999), a Medicare representative, she lamented that the number of preventative services provided by Medicare was very limited. In quoting the "Medicare and You 1999 Handbook" she explained that preventative programs which are covered by Medicare included breast exams, gynecological screening, prostate screening, and colorectal screening. But there is no preventative exercise program offered to Medicare recipients.
Another insurance company that I contacted was Tri-State UPMC Health Plan. The company's representative, who declined to give her name (personal communication, January 6, 1999), stated that the company provided a ten percent discount on various health and fitness clubs services. Many health clubs are quite expensive, and therefore a ten percent discount still may not be enough to make this option affordable for an elderly person with limited finances.
Finally, I spoke with the representative from Blue Cross of Western Pennsylvania. This representative, Alvera Prokich (personal communication, January 7, 1999), explained that those individuals insured by High Mark Blue Cross were eligible for all services provided for by insurance companies such as Tri-State UPMC Health Plan. For example, discounts were given for health and fitness clubs' memberships. Furthermore, High Mark Blue Cross provides a 100% reimbursement for participation in Tai-Chi, a very promising non-traditional preventative therapy.
Tai Chi: The Gift of Balance
Tai-Chi, a martial arts form that works to develop both balance and body awareness, involves slow, graceful, and precise body movements. Unfortunately, however, Medicare, the primary insurance carrier of the elderly, does not cover it. Relatively few elderly people can afford the expensive premiums associated with a secondary insurance carrier such as Blue Cross. Yet, studies have shown that Tai Chi helps elderly individual's from developing balance problems, thereby reducing their likelihood of falling.
An important three year study, sponsored by the National Institute of Health, reports that people aged 70 - 90, who learned and practiced the ancient art of Tai Chi, reduced injury from falling by 47.5% (Anonymous, Ancient martial art may roll back the clock, paragraph #5). According to Steven N. Blair and Melissa E. Garcia of the Copper Institute for aerobics research in Dallas, Texas, "The principal advantage of Tai Chi exercise is that it is a low-technology approach to conditioning that can be implemented at a relatively low cost in widely distributed facilities throughout the community" (Anonymous, Ancient martial art may roll back the clock, p 1). Several other studies’ results add to the growing body of evidence showing that Tai Chi preserves strength and balance thereby reducing the risk of multiple falls in older individuals.
Preventing falls in community-dwelling seniors is a very important endeavor because of the emotional and physical trauma that compromises independence and the overall well-being of older adults. Prevention could potentially eliminate the damaging physical and psychological effects a fall presents for an elderly individual and, in turn, reduce the national health care cost. However, the reality is, falls do occur and they occur at an alarming rate. Therefore, we must have a multidiscipline team that is carefully skilled in the rehabilitation of fallen elders. The most important person in the prevention and rehabilitation of falls is the individual himself/herself. In the prevention of falls, it is important the individual understands his or her risks and what preventative behaviors are the most beneficial. Increased research and access to information has led to decreases in the number of falls occurring among the elderly population. However, in order for any noticeable decrease in the frequency of falls among the elderly, many more improvements are needed in the realm of both nontraditional and traditional preventative therapies. Insurance companies need to recognize the importance of these preventative therapies and increase funds allotted for these programs. Preventative behaviors are crucial; many elderly individuals can function productively throughout their lives without ever experiencing the damaging effects of a fall if they continue these behaviors into and throughout tomorrow.
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Home modifications for Fall Prevention (Homesafe, 1998)
In the bathroom:
use non-skid floor rugs
use rubber mats or decals in the tub
install sturdy grab bars in tub and toilet area
use a bath bench and handheld shower
keep the nightlight on
In the kitchen:
keep the path clear
wipe spills up immediately
avoid or firmly secure small rugs or carpets
do not use high gloss floor wax
In the bedroom:
keep a clear path from the bedroom to the bathroom
keep the nightlight on
In the living room:
secure all carpet edges
ensure adequate lighting
keep telephone and electrical cords out of traffic lanes
avoid clutter and obstacles such as newspapers or grandchildren toys
bedroom slippers should be fastened and secure
hems on robes, long skirts, and pants, should not be too long or torn
put rubber soles on soles and heels of shoes
fasten shoes with laces or Velcro
keep paths clear of lawn mowers or any other appliance
make sure paths are well lit
loose bricks and any other unsafe footing should be repaired (Anonymous, Falling down, paragraphs #1 - #4).
AFO - ankle foot orthosis
Alzheimer's disease - a form of presenile dementia due to atrophy of frontal and occipital lobes (usually occurs between ages 40-60 and is found most often in women)
Antihypertensive drugs - drugs that prevent or control high blood pressure
Antiarrythmics - a drug or force that acts to prevent irregularity in heart action
Arrythmia - irregularity in heart action
Arthritis - inflammation of a joint, usually accompanied with pain and swelling
Aspiration pneumonia - pneumonia caused by inhaling foreign matter into lungs
Atrophy - a wasting or decreasing in the amount of tissue
Cardiovascular -involving the heart and the blood vessels
Cataracts - opacity of lens of the eye or its capsule or both
Dementia - irrecoverable deteriorative mental state with an absence or reduction in
intellectual faculties, due to organic brain disease
Diabetes - a disorder of carbohydrate metabolism resulting from inadequate production and utilization of insulin
Diabetic neuropathy - disease of nerves presented in patients diagnosed with diabetes
Diuretic - food or chemical that increases the production of urine
Extrinsic risk factor (environmental) - coming from the environment and can be modified
Glaucoma - disease of the eye characterized by increased ocular pressure resulting in atrophy of optic nerve and blindness
Hemorrhage - abnormal internal or external discharge of blood
Host - see intrinsic risk factor
Hypnotic - drug that causes insensibility to pain (sedatives, analgesics, anesthetics, and
Intrinsic risk factor (host) - due to causes within the body, an organ, or part; not merely accidental
Macular degeneration - vision impairment due to discolored spots on the lens of the eye
Mechanoreceptor - a receptor that receives mechanical stimuli such as pressure from
sound or touch
Neuromuscular- concerning both nerves and muscles
Orthosis - also known as orthotic, a device or support used to relieve or correct an orthopedic problem, functional problem with the skeletal system
Orthostatic hypotension - decreased blood pressure due to positioning of the body
Osteoarthritis - a chronic disease involving the joints and characterized by the destruction of articular cartilage, overgrowth of bone, and impaired function
Osteoporosis - a condition of fragile bones resulting from increased bone porosity
Peripheral neuropathy - disease of the nerves lying within the periphery (extremities)
Polypharmacy - patient is consuming more than three prescribed medications on a daily basis
Proprioception - the awareness of posture, movements, and changes in equilibrium, and
knowledge of position, weight and resistance of objects in relation to
Psychotropic drugs - drugs that affect psychic function, behavior, or experience
Serum glucose monitoring - testing of serous fluids found within the body to measure the level of glucose present
Stroke - see cerebrovasular accident (CVA)
Syncope - a transient loss of consciousness due to inadequate blood flow to brain