How to prevent falls in the elderly

Older people fall and injure themselves quite commonly, resulting in death, disability, or compromised quality-of-life, and health care costs. What can the doctors of British Columbia do to prevent falls?

First, some important background statistics:

• 40% of seniors over age 75 fall at least once each year.
• 10% of seniors’ falls lead to serious injury and 5% lead to fractures.
• 20% of seniors with hip fractures die within 1 year, and half of those who recover never regain full function.
• 40% of long-term care admissions are fall-related.

Fear of falling causes many seniors to walk with a cautious gait and restrict their activities. Even in long-term care facilities, recurrent falls are common.

With a population as diverse as seniors, the range of falls and injuries vary from sports-related accidents to slips while performing everyday activities.

Physicians can find helpful guidance on falls prevention in American Geriatrics Society/British Geriatrics Society Guidelines,[1] Prevention of Falls and Injuries Among the Elderly, a special report from the Office of the Provincial Health Officer,[2] and on the BC Injury Research and Prevention Unit web site.[3]

An older person’s balance and gait should be assessed in the primary care setting, and physicians should ask older patients if they have trouble with balance and falls. Once physicians identify at-risk seniors, they should be referred to local community resources such as fall prevention programs and tai chi classes.

Anyone prescribing medications to the elderly should be aware of drugs known to be problematic and associated with falls, either individually or in association with other drugs and alcohol. These include, but are not restricted to, benzodiazepines, antidepressants and muscle relaxants, and anti-cholinergic drugs. Drugs affecting blood pressure, or interacting with other drugs, may contribute to falls if orthostatic hypotension results. Thus periodic postural blood pressure readings are indicated in this population.

Beyond primary care, geriatric medicine specializes in the prevention, treatment, and rehabilitation of falls, particularly of the frail older person. However, the resources available for comprehensive geriatric assessment, treatment, and rehabilitation of seniors who have frequent falls is limited.

Specialized geriatric programs exist in the Lower Mainland and Victoria, however, this is not the case in many other parts of BC. Over the next year the BCMA Geriatric and Palliative Care Committee plans to work collaboratively with partners in fall prevention activities and to promote innovative strategies to bring specialized geriatric expertise to rural and remote area of the province. In this way we hope to contribute to promoting health and quality of life particularly among “frail” seniors and preventing avoidable falls and injury and the resulting disability.

—Duncan Robertson, MD, FRCP, FRCPC
Chair, Geriatrics and Palliative Care Committee

Dementia strategy update

“Seniors Living Well” was the Council on Health Promotion’s major project in 2003–04. Our report, Building Bridges, called for a provincial strategy on dementia. Following this report the BCMA served as a key partner in a provincial dialogue called Transforming Dementia Care in BC, held at the Morris J. Wosk Centre for Dialogue at Simon Fraser University on 4 April 2005. This meeting was a positive first step toward improving care of seniors living with dementia in BC.


References

1. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopedic Surgeons. Guideline for the prevention of falls in older persons. J Am Geriatr Soc 2001;49:664-672. PubMed Citation Full Text
2. Ministry of Health Planning. Office of the Provincial Health Officer. Prevention of Falls and Injuries among the Elderly. 2004. Full Text
3. BC Injury Research and Prevention Unit. Fall Prevention. www.injuryresearch.bc.ca (accessed 28 April 2005).

Duncan Robertson, MD, FRCP, FRCPC. How to prevent falls in the elderly. BCMJ, Vol. 47, No. 5, June, 2005, Page(s) 254 - COHP.



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