Falls in the elderly

     Falls are common, preventable and predictable in the elderly.  Education of the health practitioner is one of the greatest indicators of fall prevention measure being put in place for the senior population. Falls in the geriatric population often indicate underlining illness. Falls can have devastating health and financial consequences for the elderly. There are many evidence based interventions that have proven to reduce falls in the elderly. Identifying at risk populations and applying preventive measures can have a profound impact on public health. The family physician has a pivotal role in identifying vulnerable individuals and applying preventive measures to the older patient at risk (Al- Aama, 2011).

     Falls are the number one cause of morbidity and disability in the elderly. Falls can have irreversible health, social and psychological implications for a senior adult.  The prevention of falls is a complex manner which requires the practitioner to have an understanding about the pathophysiology behind falls. A individuals cognitive ability, muscle tone, brain chemistry, musculoskeletal structures, and sensory  processing center all play a significant role in fall prevention. As a person becomes older their gait widens, they lose muscle strength in their legs, they lose gait velocity and step length all which greatly increase an individual’s fall risk especially on uneven services. A deficiency in any of these areas can cause a fall. With ageing all these process show decline. The use of prescription medications and accumulating health problems also increase an elderly individual’s risk of falls. A person’s fall risk triples if an individual is congenitally impaired or has experienced a fall in the last year (Al- Aama, 2011).

     Risk for falls include:  previous falls, balanced impairment, decreased muscle strength, visual impairment, poly-pharmacy, psychoactive drugs, gait impairment, walking difficulty, depression, dizziness, orthostatic, being a female, advance age over 80, incontinence, diabetes, pain and vertigo.  Evidence based measures have proven that chronic pain can lead to falls in the elderly.  Sleep apnea is also a reversible risk factor for falls. The risk for falls in the elderly quadruples, for up to two weeks after discharge from a hospital stay, giving clues to the adverse reaction hospital stays can have on the senior population.  Certain medication classes also have been proven to increase a senior chance of falling. The classes of medications include:  antihypertensive agents, sedatives, hypnotics, narcoleptics, antipsychotics, antidepressants, benzodiazepines, non- steroidal anti- inflammatory drugs, and narcotics (Al- Aama, 2011).

     Screening and assessment of a person fall risk can help a health practitioner identify and eliminate risk factors to prevent falls in the elderly. A through history to include falls in the past and identifiable risk factors is significant. A physical examination should include a gait assessment, sensory assessment, neurological assessment, orthostatic vital signs, musculoskeletal assessment, depression and cognitive screening. With the finding an individualized fall prevention plan can be put in place (Al- Aama, 2011).

     Several other evidence based interventions have proven to decrease the risk of falls in elderly. Vitamin D supplements in doses greater than 800 IU/d has been shown to reduce falls. Vitamin D supplements are the only intervention that has been shown to decrease the rate of falls in long-term care.  Tia chi a low – impact exercise has been proven to increase balance, flexibility, and decrease falls in seniors. Occupational therapy, home assessments vision and hearing assessment have been proven as evidence based measure effective in decreasing falls.  Falling should not be considered a normal part of aging but, a reversible situation that is preventable (Al- Aama, 2011).

Al - Aama, T. (2011). Falls in the elderly. Canadian family
  
     physician, 57 (7), 771-776. Retrieved from http://rx9h3hy4y,sea
  
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