Preventing Falls in Older Adults

The statistics on falls among older adults are alarming. Approximately two-thirds of accidental deaths of older adults living in Rhode Island are due to injuries sustained from a fall. Falls are also the most common cause of non-fatal injuries and hospital admissions for trauma among people over age 65, according to the CDC. The medical treatment of injuries related to falls account for 80% of medical costs of people age 65 and older. Hip fractures are one of the most concerning fall-related injuries, causing the greatest number of deaths and resulting in highest rate of seniors requiring nursing home placement. Only 25% of seniors who have suffered a hip fracture will make a full recovery; 40% will require nursing home care, 50% will lose their ability to walk, and 20% will die within a year.

These statistics report the magnitude of the issue, but do not illustrate the emotional suffering seniors and their loved ones experience following a devastating fall. Not only is their health at risk, but their independence and quality of life becomes jeopardized as well.

Knowing the risk factors for falls helps in determining prevention measures. Over the past two decades, researchers have studied why falls occur and have identified the most significant risk factors. These risk factors can be grouped into three categories: biological, behavioral, and environmental. Biological risk factors include a person’s vision; chronic medical conditions such as arthritis, cardiovascular issues, and dementia; mobility problems due to muscle weakness or balance issues; and neuropathy or loss of sensation in the feet. Behavioral risk factors include inactivity, medication side effects and/or interactions, and alcohol use. Environmental risk factors include hazards in the home or environment, such as poor lighting, lack of railings, and clutter; incorrect size, type, or use of walkers and canes; and poorly designed public spaces.

Studies have shown that decreasing these risk factors significantly reduces falls among people living independently in the community. Educating older adults and their loved ones about fall risk factors on an ongoing basis is the most effective way to reduce the number of falls nationwide. Because

Rhode Island has a high percentage of older adults living in our community, fall prevention is an area of great concern to public health and safety. Community-based fall prevention programs target five main areas to reduce the risk of falls to seniors:

1. Education of seniors and their loved ones about why falls occur and how to reduce risk factors.

2. Exercise to improve strength, balance, and mobility. This can include simple activities like walking or modest home exercise programs (with the appropriate supervision level determined by one’s physician) or more advanced programs such as Tai Chi, which can improve balance and strength. Tai Chi and other advanced programs should be taught by trained, certified instructors or physical therapists.

3. Medication review by a pharmacist or health care provider to identify possible side effects or drug interactions that may increase fall risk. A physician needs to authorize any change to a prescription medication.

4. Vision exams should be conducted at least annually by a trained professional.

5. Home safety assessment by an occupational therapist or health care professional can identify hazards in the home and measures to correct any issues. Simple changes, such as removing scatter rugs and clutter or using nightlights, can have a big impact on home safety. More expensive upgrades in the bathroom can be worthwhile if the senior plans to stay in the home long term.

Addressing the risk factors before a fall occurs is essential to preventing a devastating incident and can help older adults live longer, more independent lives.

PATRICIA HARWOOD is a licensed clinical social worker at Jewish Family Service of Rhode Island.