Prevention of falls and consequent injuries in elderly people
Submitted by: Carolyn S. Wilken, Ph.D., M.P.H.
Prevention of Falls and Consequent Injuries in Elderly People. Kannus, P., Sievanen, H, Palvanen, M., Jarvinen, T. & Parkkan, J. Lancet 2005; 366: 1885–93 Retrieved September 17, 2006.
Introduction
Injuries from falls is a serious concern for older adults, their family members and the professionals who provide care for them. An elderly person who falls may suffer long-term pain, disability, and even death. As the number of older adults continues to rise, the number of falls is expected to increase correspondingly. Researchers have found that fall prevention includes several components, including regular exercise including both strength and flexibility training, attention to nutrition particularly vitamin D and calcium supplements, reducing or withdrawing certain medications, vision assessments such as cataract surgery, and an environmental evaluation to remove tripping hazards and lighting deficiencies. These prevention methods apply both to elders living at home and those living in institutions.
Methodology
This article is a review of current research (up to May 31, 2005) related to falls among the elderly population world-wide. Articles included in this review were published in two premier medical databases Medline and PubMed, relevant journals and congress abstracts.
Main Ideas
Falls are a significant cause of injury and death among older adults, particularly elderly women. Risk of falling is important among both community dwelling elders and those residing in institutions as 30% of people over 65 years of age living in the community fall each year, and nearly half of older adults living in an institution fall. A key concern regarding falls is that more than half of those who fall will likely suffer additionally falls over time. Furthermore, injuries are the fifth leading cause of death among the elderly, and 80% of these injuries are the result of falling. Among those over 65 who fall, 20% need medical attention (5% for fractures, including head injuries). Statistics regarding falls generally double for women over the age of 75 because of the high incidence of osteoporosis.
After reviewing the literature on falls, the authors recommend a multi-pronged approach, including exercise, diet, medication evaluation, and environmental adaptations. Exercise recommendations involve both strength building through weight bearing exercises (i.e. standing, walking, and stair climbing) and flexibility training such as Tai Chi. Strength and flexibility promote balance, reaction time and gait. What we don’t understand is the frequency and level of exercise needed at various ages.
The literature appears to be consistent in the recommendation of Calcium and vitamin D supplementation as a positive approach to reducing injury resulting from falls by increasing bone density. Because calcium and vitamin D are both reasonably inexpensive the combination serves as an effective population-based injury prevention strategy.
Although only one study was found to include in this review, the reduction of psychotropic drugs used primarily as treatment for mental illness, reduction of the drugs resulted in a 66% reduction in the number of falls.
Researchers have found that professional analysis of the home environment and related adaptations can lead to a significant reduction in the number of falls for those at high risk of falling.
Although past research has focused on single factors associated with falling, such as exercise, diet, nutritional supplements and the environment, the authors recommend additional research on the effectiveness of multi-factorial approaches to reducing the risks of falling. Also needed is research based on diverse populations (e.g. age, ethnicity), and including elders suffering myriad illnesses, utilizing a variety of drugs, and focusing on numerous causes of falling in addition to osteoporosis.
Implications for Extension Programs
Because falls are a constant worry to older adults, their families and their caregivers, the topic provides an important opportunity for Extension educators to combine programming in nutrition, housing, health (exercise), and aging. Such programs can be directed at older adults as well as their caregivers and can be presented at senior centers, nutrition/feeding sites, and many other program locations.
For programming materials directly related to falls, see Aging in the 21stCentury for the program developed by Kristen Smith titled Florida Injury Prevention Programs for Seniors (FLIPS). The EDIS publication is found at http://edis.ifas.ufl.edu/FY629 and the related PowerPoint presentation can also be found at the IFAS Presentations website at http://presentations.ifas.ufl.edu/ The complete FLIPS program can be found at the Florida Department of Elder Affairs website at http://elderaffairs.state.fl.us/english/flips.html A complete series on fall prevention is also on EDIS and can be found at EDIS Topic Series: Fall Prevention
