What safety measures can be taken to prevent falls in elderly individuals at high risk?

Safety Measures for Elderly Individuals at High Risk for Falls

Exercise or physical therapy and vitamin D supplementation are the most effective interventions to prevent falls in elderly individuals at high risk. 1

Risk Assessment

• Ask all older adults about falls at least once per year 2, 3
• Identify high-risk individuals using:
  • History of falls 1
  • Mobility problems 1
  • Timed Get-Up-and-Go test (normal is <10 seconds) 1
• For those reporting recurrent falls, perform a comprehensive fall evaluation including:
  • Circumstances of prior falls 2
  • Medication review 2
  • Assessment of medical conditions 2
  • Evaluation of gait, balance, and mobility 2, 3

Evidence-Based Interventions

Exercise and Physical Therapy (Grade B Recommendation)

• Implement exercise programs focusing on:
  • Balance training 1
  • Gait training 1
  • Strength training 1, 3
• Exercise interventions can range from low intensity (≤9 hours) to high intensity (>75 hours) 1
• The U.S. Department of Health and Human Services recommends:
  • 150 minutes per week of moderate-intensity or 75 minutes per week of vigorous-intensity aerobic activity 1
  • Muscle-strengthening activities twice per week 1
  • Balance training 3 or more days per week for those at risk for falling 1
• Tai Chi is a promising balance exercise option 3

Vitamin D Supplementation (Grade B Recommendation)

• Provide vitamin D supplementation at 800 IU daily 1
• Treatment duration should be at least 12 months for effectiveness 1
• The American Geriatrics Society recommends 800 IU per day for persons at increased risk for falls 1

Medication Management

• Review and modify medications, particularly:
  • Psychotropic medications 2, 3
  • Polypharmacy (four or more medications) 3, 4
• Consider gradual withdrawal of fall risk-increasing drugs when possible 3

Environmental Modifications

• Assess and modify home hazards:
  • Remove tripping hazards 3
  • Improve lighting 3
  • Install grab bars in bathrooms 4
  • Secure loose rugs or remove them entirely 4
  • Ensure adequate lighting in stairways 4

Additional Interventions

• Treat postural hypotension if present 1, 3
• Optimize vision with appropriate correction 2
• Consider podiatry care for foot problems 4
• Provide appropriate assistive devices with proper training 2, 3

Multifactorial Risk Assessment and Management

• The USPSTF does not recommend automatically performing an in-depth multifactorial risk assessment with comprehensive management for all older adults (Grade C recommendation) 1
• However, multifactorial assessment and intervention may be appropriate for:
  • Those who have had 2 falls in the past year 1
  • Those who have had 1 fall with gait or balance problems 1
  • Those presenting with an acute fall 1
• The most effective components of multifactorial assessment include:
  • Evaluations of balance and mobility 1
  • Vision assessment 1
  • Orthostatic or postural hypotension evaluation 1
  • Medication review 1
  • Home environment assessment 1

Common Pitfalls to Avoid

• Relying solely on fall risk screening without implementing targeted interventions 3
• Overlooking medication review, especially psychotropic medications 3
• Failing to address multiple risk factors in high-risk individuals 3
• Neglecting to follow up after implementing interventions 3
• Not considering admission if patient safety cannot be ensured 2

Special Considerations

• Consider teaching safe-falling strategies to reduce impact forces and minimize injury when falls do occur 5
• For those discharged after a fall, arrange expedited outpatient follow-up including home safety assessments 2
• Counsel patients and families about fall risk, home safety, activity restrictions, and supervision needs 3