From the Guidelines
Effective geriatric fall management requires a comprehensive approach combining physical therapy, environmental modifications, and medication review, with a focus on balance training, strength exercises, and gait training, as well as vitamin D supplementation and medication adjustment, to improve muscle strength, enhance proprioception, and reduce environmental hazards, as recommended by the USPSTF 1.
Key Components of Geriatric Fall Management
- Physical therapy: balance training, strength exercises (particularly lower extremity), and gait training, ideally 2-3 times weekly for at least 12 weeks, with exercises like chair rises, heel-toe walking, and single-leg stands being particularly beneficial 1
- Environmental modifications: removing tripping hazards, installing grab bars in bathrooms, ensuring adequate lighting, and using non-slip mats
- Medication review: certain medications including benzodiazepines, sedative-hypnotics, antipsychotics, and some antihypertensives can increase fall risk, and should be adjusted or discontinued if possible, as recommended by the geriatric emergency department guidelines 1
- Vitamin D supplementation: 800-1000 IU daily with calcium for those with deficiency, as recommended by the USPSTF 1
- Assistive devices: canes or walkers should be properly fitted and used correctly
Importance of Regular Reassessment
Regular reassessment every 3-6 months is crucial to track progress and adjust interventions as needed, with the goal of maintaining independence and preventing the serious consequences of falls like fractures and hospitalization, as highlighted in the geriatric emergency department guidelines 1
High-Risk Injuries and Comprehensive Assessment
High-risk injuries such as blunt head trauma, spinal fractures, and hip fractures warrant a higher degree of suspicion and extensive workups, and a comprehensive assessment of the cause of the fall and an estimation of future fall risk is essential, as recommended by the geriatric emergency department guidelines 1
From the Research
Geriatric Fall Management
- Falls are a major cause of injury and death annually for millions of individuals 65 and older, with an estimated 25% of older adults falling each year 2.
- Older adults are at risk for falls due to various reasons, including biologic, behavioral, environmental, and socioeconomic risk factors 2.
- A 10-step protocol, including screening for falls, comprehensive fall assessment, gait and balance screening, and an individualized fall intervention program, can help identify individuals at risk for falls and reduce fall risks 3.
Physical Interventions
- Vitamin D supplementation has been considered a potential intervention to prevent orthostatic hypotension (OH), but studies have shown mixed results 4, 5.
- A study found that higher doses of vitamin D3 supplementation did not reduce the risk of OH or orthostatic symptoms in adults ages 70 and older 4.
- Another study suggested that lower vitamin D status was associated with an increased risk of OH in older adults, but further studies are needed to explore this relationship 5.
Multidisciplinary Care Pathways
- Multidisciplinary care pathways for falls prevention, including falls risk stratification, multifactorial falls risk assessment, and management of multidomain interventions, can reduce falls in older adults 6.
- Effective multidisciplinary falls prevention care requires a dedicated case manager, preparatory patient information, small multidisciplinary care teams, patient involvement, good communication between healthcare professionals, and a reduction in workload for healthcare professionals 6.
- The inclusion of a case manager program for older adults and access to resources to facilitate good communication between healthcare professionals are important to optimize the configuration of multidisciplinary care pathways for falls prevention 6.