What are the ways to prevent falls in the elderly?

Fall Prevention in the Elderly

A comprehensive multifactorial assessment and intervention approach is essential for all elderly patients to prevent falls, including medical evaluation, physical therapy referral, home safety assessment, and medication review to reduce morbidity and mortality. 1

Risk Assessment and Screening

Initial Screening

• All older persons should be asked at least once a year about falls 2
• Three key screening questions to identify increased fall risk:
  1. Have you fallen in the past year?
  2. Do you feel unsteady when standing or walking?
  3. Are you worried about falling? 1

Physical Assessment

• Perform the "Get Up and Go Test" for all elderly who report a single fall (observe as they stand up from a chair without using arms, walk several paces, and return) 2
• Those demonstrating difficulty or unsteadiness require further assessment 2
• The Timed Up and Go (TUG) test indicates increased fall risk if time is greater than 12 seconds 1
• The 4-Stage Balance Test indicates increased fall risk if the patient cannot maintain a tandem stand for 10 seconds 1

Comprehensive Fall Evaluation

For those who present with falls, report recurrent falls, or show gait/balance abnormalities:

• History of fall circumstances, medications, medical problems, mobility levels
• Vision examination
• Gait, balance, and lower extremity joint function assessment
• Basic neurological function examination (mental status, muscle strength, proprioception, reflexes)
• Cardiovascular assessment including postural blood pressure 2

Multifactorial Interventions

For Community-Dwelling Elderly

1. Exercise Programs

   • Balance and functional training
   • Resistance/strength training
   • Flexibility exercises
   • Gait training
   • Frequency: 3 sessions per week for 12 months
   • Duration: 50-60 minutes daily 1, 3
   • Exercise interventions can reduce falls from 850 to 655 per 1000 patient-years (rate ratio 0.77) 3

2. Medication Review and Modification

   • Review and modify medications, especially:
     • Psychotropic medications
     • Vasodilators
     • Diuretics
     • Antipsychotics
     • Sedative/hypnotics 2, 1
   • Reduce polypharmacy and adjust timing/dosage 1

3. Home Safety Assessment and Modifications

   • Remove tripping hazards
   • Install handrails and grab bars
   • Improve lighting
   • Ensure even floor surfaces 1
   • Environmental modifications for high-risk individuals can reduce falls (risk ratio 0.74) 3

4. Treatment of Medical Conditions

   • Manage postural hypotension 2
   • Treat cardiovascular disorders, including arrhythmias 2, 1
   • Address foot problems and footwear 2, 1
   • Vision assessment and correction 1
   • Consider cataract surgery (risk ratio 0.68) 3
   • Multicomponent podiatry interventions (risk ratio 0.77) 3

For Long-Term Care and Assisted Living Settings

1. Staff education programs
2. Gait training and advice on assistive devices
3. Medication review and modification 2

Special Populations

Stroke Patients

• Implement specific falls prevention plan
• Skills training for safe transfers and mobility 1

Osteoporosis Risk

• Bone health assessment and appropriate treatment
• Consider Fracture Liaison Service (FLS) for systematic risk evaluation 1

Frail Elderly

• Refer to specialist care of the elderly team
• Include physical therapist in care team
• Coordinate with primary care provider and social worker
• Consider complete geriatric assessment 1
• Reassess frailty status every 1-2 years 1

Follow-up and Reassessment

• Reassess fall risk at all transition points and whenever there is a change in health status 1
• Expedite outpatient follow-up, including home safety assessments 1
• Monitor functional status and quality of life for improvement 1

Effectiveness of Interventions

• Multifactorial interventions can reduce falls from 2317 to 1784 per 1000 patient-years (rate ratio 0.77) 3
• Exercise interventions reduce falls by 23% and the number of people who fall by 15% 3

Common Pitfalls to Avoid

• Underestimating fall risk in patients with cognitive impairment 4
• Failing to recognize syncope as a cause of falls (20% of cardiovascular syncope in patients over 70 appears as a fall) 4
• Neglecting to assess medication side effects, especially from antihypertensives, diuretics, and benzodiazepines 4
• Overlooking environmental hazards in the home setting 1
• Focusing on single interventions rather than comprehensive approaches 3

By implementing these evidence-based strategies, healthcare providers can significantly reduce the risk of falls and their potentially devastating consequences in the elderly population.