Are You Headed For A Fall?

Smart steps for safer seniors start with risk assessment, prevention tips.

From the moment we take our first steps, we are encouraged to get up and walk again any time we stumble and fall. As people age, however, the ability to avoid injury and recover from a spill fades significantly.

A fall is medically defined as “any event that results in a person inadvertently coming to rest on the ground, or a level below where they were,” and in people 65 and older, falls are the most common cause of nonfatal injuries.

Falls are also the leading cause of accidental deaths among people 65 and older, and with nearly one in every three seniors experiencing an accidental fall each year, medical consultant Marc S. Berger, MD, says it’s an issue that requires attention.

There are two types of falls: preventable and unpreventable. If something happens that is out of your control and cannot be anticipated, that’s a unpreventable fall, Dr. Berger educates.

“What needs to be addressed are the preventable falls, the ones that we have more control over, such as those caused by improper use of a cane, poor fitting footwear, dizziness due to a treatable cause, and hazards at home like loose rugs and extension cords,” the doctor notes.

“Some unanticipated falls are unpreventable, such as tripping over a pet dog, missing a step or stumbling on an irregular walkway or uneven ground. They just happen. But there are falls that we can assess and modify the risk for, and there are also falls that may be preventable that occur because someone may be dealing with a medical issue that they do or don’t know about.

“That’s why a medical assessment should be performed any time a fall results in an injury that requires medical attention. That allows us to get to the bottom of why that person fell and discuss changes that can be made to prevent another fall.”

An Ounce of Prevention

Prevention is particularly important when dealing with seniors who have suffered a fall. Research shows that seniors who have fallen once are three times more likely to fall again in the next six months compared with someone who has not suffered a fall.

The first step in such an assessment is to learn how the fall happened and whether it could have been prevented. That typically starts with a gait assessment, where a physician watches how you walk, and a detailed review of medications and medical conditions is done.

“We look to see if someone has a foot drop, where you have difficulty lifting the front part of your foot,” the doctor details. “Do you have a wide gait, or do you shuffle or drag your feet? Can you maintain your balance? Do you properly use a walking aid such as a cane? Do you have a weakness in one foot or other parts of your body?

“During a gait assessment, we look to see if someone has irregular shoe wear on one shoe compared to the other, because that can be a sign of an irregular walking pattern or some other problem that needs to be addressed. We also check if someone can balance, walk on their toes or on their heels because that can tell us a lot about their strength. We also assess overall strength and conditioning. If we find that to be poor, we’ll recommend physical therapy or strength and conditioning exercises.”

The goal is to get better and avoid a second fall.

“We encourage people to do balance exercises,” Dr. Berger says. “We often recommend tai chi, because we’ve found that this exercise program can help someone decrease their risk of falls by 29 percent. Tai chi is done standing up. It’s a slow-moving exercise that improves balance, poise and strength; yoga has not been shown to be as beneficial. Other exercises we recommend include walking, swimming and walking in a pool, which is great for the lower joints and muscles.”

Assessments can also include what is known as a Timed Up and Go (TUG) test, where a person is asked to get up from a chair, walk 10 feet, turn around and walk back to the chair and sit down, in less than 15 seconds. Anyone who struggles or is very slow is likely more susceptible to a fall.

Beyond the Basics

Studies show that women older than 65 are more likely to fall than men older than 65. Because of that, Dr. Berger says it’s important for women to get regular bone density scans and osteoporosis assessments.

Osteoporosis and its precursor, osteopenia, are potentially severe conditions that can greatly increase the risk of bone fractures. About 54 million Americans have osteopenia, osteoporosis or low bone mass, which also places them at increased risk for the hip, spine, wrist and other bone fractures commonly associated with osteoporosis. The conditions are found most often in postmenopausal women, but men can suffer from them as well.

Anyone with osteoporosis or osteopenia may be more likely to sustain a bone break from a fall, or even a minor trauma, which can also come as a result of certain medical conditions or the medications someone might be taking to combat a medical condition.

“A lot of drugs can increase your chances of falling,” Dr. Berger confirms. “The most notable are sleeping pills, but cold medications and blood pressure medicines can really increase your risk of falling as well.

“As for conditions, people with Parkinson’s disease are 2.7 times more likely to fall than someone who doesn’t have that disorder, while people with musculoskeletal issues such as chronic aches and pain and arthritis are 5.3 times more likely to suffer a fall.

“Even the use of an aid, such as a cane or walker, increases one’s risk for a subsequent fall, because those people already have impaired walking and need the aid.”

Carotid stenosis, orthostatic hypotension and cardiac arrhythmias can also lead to falls.

“That’s why it’s important to go beyond the basic assessment and get a specialist involved when needed,” Dr. Berger states.

For an initial fall with injury, often the emergency room can do a preliminary assessment. A thorough medical assessment should be performed after a second fall.

Reducing the risk of falls can sometimes be as simple as changing footwear, but it can also be as complicated as changing medications or diagnosing heart or brain problems, vision issues, hearing issues and other problems that could lead to unexpected falls.

“For some people, all they need to do is remove a rug from a hallway or put a night light in the bathroom, so they can see better when they get up in the middle of the night, or substitute a medication with less side effects,” Dr. Berger suggests.

“Some of the solutions are very simple. Others may be more complicated and require the help of a physician. Either way, it’s important to have these assessments so that potentially preventable falls leading to injury and, yes, even death, can be avoided in the first place.”

© FHCN article by Roy Cummings. js
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