What is fall prevention?
Fall prevention is a program designed to decrease the number of fall injuries, especially in the elderly population in which it is one of the most common causes of injury. An approximate of 646000 people die due to fall accidents yearly and more than 3 million elderly present in the emergency department following fall injuries yearly in the U.S. Fall injuries are especially common in the elderly which may be due to a number of reasons such as reduced reflexes, senile osteoporosis, and chronic illnesses. Accidental injuries rank fifth in causes of death in the elderly and often result in fractures and head injuries which reduce their quality of life in cases of survival.
Risk factors for fall injuries
Some of the common risk factors for fall accidents are described below:
Falls accidents in young people without comorbidities
Although more common in the elderly, fall accidents can also occur in young and otherwise healthy individuals. Accidents such as wet floors, improper footwear, poor lighting, uneven flooring, or a sedentary lifestyle can lead to falls in young people. Falls in young adults most commonly result in fractures at the limb joints such as wrist, knees, and ankles.
Fall injuries are a common cause of morbidity and mortality in elders above 65 years of age with 1 in 4 people aged 65+ in the U.S succumbing to fall injuries each year. Fall accidents in the elderly can have numerous reasons, but the most common causes are described below:
- Gait abnormalities- These are any changes in the normal gait of a person and in old age usually results in a slower pace and reduced length of stride. It is usually the result of some underlying problems such as poor proprioception, decreased vision, arthritis of the hips or knees, or frontal gait disorder and can increase the chances of falls in the elderly.
- Surrounding environment- Unstable or wet flooring, absence of hand railings, or improper footwear can cause accidental falls in the elderly and may lead to severe injuries or fractures.
- Neuronal disorders- Damage of neurons responsible for visual, sensory, motor, and cognitive function can lead to increased chances of falls in the elderly as well as more severe injury if the reflexes are also affected. Balance dysfunction can also cause vertigo, syncope, and poor balance and can lead to a fall injury.
- Medication- With age, the number of medications used also increases, and chronic use of multiple medications was seen to increase the chances of fall accidents. Medication such as benzodiazepines, antidepressants, diuretics, and many others contribute to a higher risk of falls.
Fall injuries are common in stroke patients with 30% of stroke patients suffering fall injuries at least once a year and 15% of patients falling more than once due to stroke. Even after recovery some patients suffer from complications such as deviations in gait, decreased tone and weakness of muscles, hemianopia, visuospatial deficits, etc.
Parkinson’s disease is a chronic disorder that mainly results in the degeneration of the motor neurons. Early symptoms of the disorder include tremors, rigid posture with difficulty in walking which may lead to increased chances of fall accidents. A study conducted in the UK shows that 68.3% of Parkinson’s patients suffered from fall accidents.
Multiple sclerosis is a chronic condition that affects the brain and spinal cord and may lead to life-long disability. Patients of multiple sclerosis are highly likely to have fall accidents with nearly 52.2% of patients reporting fall accidents due to symptoms such as abnormal gait, ataxia, impaired vision, cognitive disability, etc. The prevalence of falls was also associated with risk factors such as male gender, poor balance, worsening health status, bladder incontinence.
Ways to decrease fall accidents
Fall prevention includes multifactorial intervention programs that have shown a 27% reduction in falls in the elder population and a 14% reduction in those with a previous history of falls or other risk factors. The same study also deemed strength and balance exercises, tai chi, house risk assessment, withdrawal of psychoactive drugs, and using cardiac pacemakers in patients with increased sensitivity of the carotid sinus as the best ways to reduce fall risk. Strategies for fall prevention aim to not only identify the risk factors contributing to an increased risk of falls but also look for ways to avoid or eliminate these factors. Fall accidents are most commonly seen in individuals above 65 years of age and usually as a consequence of symptoms of certain chronic diseases.
Exercise is one of the most essential interventions as a fall prevention strategy in older adults as it helps build and maintain muscle strength that is usually lost with age. Resistance exercises are seen to be especially beneficial since they not only prevent falls but also enhance body mobility and endurance for daily tasks such as walking, and climbing stairs. To achieve this, a proper training regimen following a daily recommended exercise should be established with resistance exercises, balance training, and other exercises. Research has shown that continuous resistance training can decelerate the loss of muscle mass and reduce the risk of falls in the elderly.
Home hazard assessment
The environment of a person can present many obstacles for people of age and those with disabilities which increases their risk of fall injuries. Stairs, bathtubs, tile flooring, etc are commonly associated with fall accidents, and assessing these risks early on can help the elderly to carry on their daily life activities. A home assessment is followed by changes to eliminate these risk factors such as installing support bars and non-slip mats in bathrooms, staircases, and other surfaces to avoid slipping. The use of ambulatory assistive devices such as canes, crutches, and support frames can provide stability and extra support for patients with poor mobility and balance.
Lighting also plays an important role in fall prevention by helping the patient visualize and avoid potentially hazardous areas or objects. Improved lighting can provide important visual cues that enhance stability and postural control and therefore create a safer environment for the elderly population.
- de Niet MSc M, van Duijnhoven MSc HJ, Geurts AC. Falls in individuals with stroke. Journal of rehabilitation research and development. 2008 Sep 10;45(8):1195.
- Wood BH, Bilclough JA, Bowron A, Walker RW. Incidence and prediction of falls in Parkinson’s disease: a prospective multidisciplinary study. Journal of Neurology, Neurosurgery & Psychiatry. 2002 Jun 1;72(6):721-5.
- Finlayson ML, Peterson EW, Cho CC. Risk factors for falling among people aged 45 to 90 years with multiple sclerosis. Archives of physical medicine and rehabilitation. 2006 Sep 1;87(9):1274-9.
- Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH. Interventions for preventing falls in elderly people. Cochrane database of systematic reviews. 2003(4).