Senior men and women are susceptible to falling down
Senior men and women are susceptible to falling down

Older people are always under the hood of falling as their bones get weak with passing time. Falls seize the person’s ability to walk independently without any support. But falls are not because of one problem, multiple factors when left unattended, combine to affect normal walking resulting in falls.

Why falls are left untreated is the important question here. Sometimes, patients don’t inform their health care providers about the falls, or a provider doesn’t ask about such events. Both parties can be of the high opinion that falls are closely related to the aging process. This failure of communication causes fall events to get lost somewhere in the back. Providers often fail to investigate the causes of the falls to provide accurate treatment for injuries. So, just as a quick go-through, this article will cover the preventive measures to avoid falls in the elderly.

Risk Factors:

Multiple causes are involved with falls in the elderly. Our body is provided with homeostatic
mechanisms to maintain posture and stability. If any threat attacking the homeostatic mechanism
surpasses the age-related declines in balance, gait stability, and cardiovascular functions, falls occur. These threats are in the form of acute illness (like fever, dehydration, arrhythmia), any new medication, environmental stress (like unfamiliar surroundings), or a dangerous walking area. Immobile Patients are not at risk, even with the presence of these threats.

Risks are associated more with vigorous and frail patients. Vigorous older patients can have more risks, while the frail older patients fail to maintain postural stability even in case of minor threats.

The following risk factors are prominent in having a role in falls in older adults.

  • Past history of a fall
  • Lower-extremity weakness
  • Age
  • Female gender
  • Cognitive impairment
  • Balance problems
  • Psychotropic drug use
  • Arthritis
  • History of stroke
  • Orthostatic hypotension
  • Dizziness
  • Anemia

While fall-related injuries like fracture, dislocation, or laceration requiring suture are associated with the following risk factors.

  • Fall as a result of syncope
  • History of fall plus injury
  • Reduced executive function measured by Trail Making B time

Prevention:

Different studies suggested different preventive measures for falls. They may be educational programs
and the use of different strategies to improve strength or balance, changes in the medications, and
modification in the environmental factors imposing in homes or institutions. These interventions can
target only one risk factor or a combination of risk factors.

The following interventions may help in preventing falls.

1. Exercise:

Exercise is the most beneficial intervention that has a positive effect on falls and injurious falls. Patients with a history of falls may start with a combination of exercise techniques for strengthening muscle and balance.

There are a variety of exercises that are effective enough to encourage the elderly to prevent falls. They are strength & balance, and resistance training like tai chi, step training that involves training for correct and adequate steps, and treadmill training. Targeted exercise training by a physical therapist for patients who have undergone a fall previously. A minimum of three hours of training per week is considered to give the best results.

In some randomized trials, the following exercises were proven to be the best.

  • Gait and balance training
  • Strength training
  • Movement (such as tai chi or dance)
  • Aerobic

2. Alteration in Medication:

Healthcare providers must be aware of when to stop, change, or alter the medication. Psychotropic
drugs like benzodiazepines, sedatives, antidepressants, and antipsychotic agents trigger the fall risk in the elderly.

In one placebo-controlled trial, gradually decreasing psychotropic drugs decreased the rate of falls but not the risk of falling. The latter got reduced when medication modification was combined with
interventions from the physician side like a financial reward, prescriptions feedback, academic details.

3. Vitamin D Supplements:

If a patient is low on vitamin D, initiating a vitamin D supplementation will be necessary as it strengthens the bones. But unfortunately, the use of vitamin D supplements have not a direct role in preventing the risk of falls. Even a trial confirmed this fact on African and American women. So, using it on all the elderly is discouraged.

So, patients who are at greater risk are recommended to take vitamin D supplementation. Those elderly
having a risk of low vitamin D because of an inadequate diet, less sun exposure, malabsorption, obesity, and slow gait speed must be provided with empiric supplementation in place of measuring the initial 25-OH-D serum concentrations.

4. Environmental Modifications:

Home safety measures have a role in reducing the risk of falling in at-risk older patients. In one trial, the use of home safety interventions in preventing fall injuries reduced to over three years. These interventions include fixing stair handrails, grab rails in bathrooms, good lights, nonslip deck surfaces, and bath mats, and a pamphlet on home safety.

Moreover, the use of multifocal glasses during outdoor activities and nonslip footwear may help in
reducing the risk of falling in the elderly.

5. Education:

The elderly should be aware of how to prevent fall risk. But using it as the only mean of fall prevention would be irrational. It’s better to keep educating the elderly in combination with other inventions. By strategizing the preventive measures, the falls can be reduced in the elderly. Make sure that the comorbidities like carotid sinus hypersensitivity, cataract, malnutrition, postural hypotension, excessive foot pain, osteoporosis, get treated. Because that is how one can be able to control the fall risk in the elderly.

Elderly Fall Prevention



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I am chief medical resident doctor in Internal Medicine at a tertiary care hospital. I am also an author and editor at StatPearls publishing, a medical website with thousands of PubMed indexed articles and MCQs.

Tagged on: balance    bones    dislocation    elderly    falling    fracture    hip fracture    osteoporosis    prevent falls    seniors    stairs    Vitamin D Supplements    walking
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