Reducing the risks of falls in the elderly

Dr. Mary Tinetti of Yale University School of Medicine in New Haven, Connecticut tells us “Falls are one of the most common health problems experienced by older adults and are a common cause of losing functional independence.” The American Geriatrics Society (AGS) recommends that healthcare professionals use their guidelines as a routine part of healthcare for the elderly. An algorithm for patient assessment provides a road map for evaluating all older people encountered by a health care provider.

• Each step in the algorithm is accompanied by links that present detailed, referenced recommendations.

The bottom line? CAM plays a major role in the AGS approach to preventing falls. Here are the recommendations.

• Minimize Medications
  • Medications have consistently been associated with increased risk of falls.
• Initiate an Individually-tailored Exercise Program
  • Evidence supports the recommendation that exercise, in the form of resistance (strength) training, and balance, gait and co-ordination training, is effective in reducing falls.
  • The reduction in fall rate resulting from exercise is modest (approximately 16%).
• Treat Vision Impairment
  • Although correction should intuitively improve fall risk, there are insufficient data to support this intervention alone.
• Manage Postural Hypotension
  • Modification and simplification of medications, have shown benefit for fall prevention
• Manage Heart Rate and Rhythm Abnormalities
  • Cardiovascular factors are frequently cited as risk factors for falls.
  • Treat as appropriate to correct slow and rapid heart rates.
• Supplement with Vitamin D
  • Vitamin D deficiency is common among older people and impairs muscle strength and possibly neuromuscular function.
  • Provide vitamin D supplements of at least 800 IU per day to older persons with proven vitamin D deficiency.
  • Provide vitamin D supplements of at least 800 IU per day should be considered for people with suspected vitamin D deficiency or who are otherwise at increased risk for falls.
• Manage Foot and Footwear Problems
  • Serious foot problems (ie, moderate or severe bunions, toe deformities, ulcers or deformed nails) predispose older adults to falls.
• Modify the Home Environment
  • Screening the home environment with follow-up for any needed modifications by a health care professional is effective for people with a previous fall history or other fall risk factors.
• Provide Education and Information
  • All fall prevention programs should include education intended to raise the awareness of the older person and/or health care workers about risk factors for falls and inform them about strategies to minimize risk.

1/16/11 20:27 JR

6/10/19. Here is a recent link to the Age-in-Place Guide that might be useful in developing a fall prevention program.