Falls prevention: The lifelong battle against gravity

Issue: BCMJ, vol. 66, No. 8, October 2024, Council on Health Promotion
By: Eileen M. Wong, MD, CCFP, FCFP Michael Slatnik, MD, MPH, CCFP

Falls are a major cause of morbidity and mortality in older adults; they also cost the BC health care sector $1.1 billion in 2018.[1] The BCMJ has published many articles about falls prevention for older adults; what remains salient and what is new?

The BC Guideline Fall Prevention: Risk Assessment and Management for Community-Dwelling Older Adults,[2] published in June 2021 for use by primary care practitioners and summarized in the BCMJ,[3] addressed how to identify and manage adults 65 years of age and older in the community with risk factors for falls. Although hospital, facility-based care settings, and acute fall management are outside of the guideline’s scope, some of the principles may be useful in those settings. Guideline recommendations for physicians include:

  • Conducting an annual screening with a “three-questions approach” or “staying independent checklist” [Box].
  • If a screening is positive, doing a multifactorial risk assessment (reviewing medications; medical conditions like frailty, impaired safety awareness, impulsivity, impaired mobility, and osteoporosis; and the home environment).[2,3]
  • If available, suggesting a Falls Prevention Clinic[4] or Osteofit program.[5]

The most effective falls prevention intervention is exercise to improve strength,[6,7] gait and balance training (e.g., walking backward),[8] core exercise training,[9] and safe mobility. Since sarcopenia[10-12] is closely related to falls risk, resistance training[11] is recommended as well.

Future prevention efforts may target those most at risk: women, adults age 80 and older, and those living alone or on a low income. Falls occur mainly in the household or while walking.[13]

National Seniors Day is 1 October, and November is Fall Prevention Month.[14] Let’s remember that falls prevention is so much more than removal of rugs in this lifelong battle against gravity.

Acknowledgments

Special thanks to Drs Ken Madden, Amanda Hill, and Janet Kow from the Division of Geriatric Medicine at the University of British Columbia for their input into the content for this article.
—Eileen M. Wong, MD, CCFP, FCFP
Council on Health Promotion Member
—Michael Slatnik, MD, MPH, CCFP
Council on Health Promotion Member

BOX. Risk factors for falls, screening tools, exercises, and resources.

Who is at greatest risk:

  • Women
  • Anyone age 80 and older
  • Those living alone or on a low income
  • People with medical conditions including frailty, sarcopenia, cognitive impairment, and osteoporosis

Screening tools:

  • Three-questions approach:
  1. Have you fallen in the past year? If so:
  • How many times?
  • Were you injured?
  1. Do you ever feel unsteady when you stand or walk?
  2. Do you worry about falling?

Exercises:

  • Strength: resistance exercises, lifting weights, wall pushups.[6,7]
  • Balance: tai chi, standing on one foot, heel-toe walk, balance walk, standing from seated position,[6,7] backward walking.[8]
  • Core: bridges, planks, opposite arm and leg raises.[9]

Resources:

For patients:

For practitioners:

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This article is the opinion of the authors and not necessarily the Council on Health Promotion or Doctors of BC. This article has not been peer reviewed by the BCMJ Editorial Board.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

1.    BC Injury Research and Prevention Unit. Cost of injury in British Columbia. Accessed 24 July 2024. www.costofinjury.ca/bc/cost-of-injury-in-british-columbia.

2.    Government of BC. Fall prevention: Risk assessment and management for community-dwelling older adults. BC Guidelines. Last updated 28 August 2023. Accessed 8 July 2024. www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/fall-prevention.

3.    BC Medical Journal. Recently published BC Guidelines. BCMJ 2021;63:368-369. Accessed 8 July 2024. https://bcmj.org/news/recently-published-bc-guidelines-1.

4.    Falls Prevention Clinic. Falls prevention. Accessed 8 July 2024. http://fallsclinic.ca.

5.    BC Women’s Hospital and Health Centre. Falls prevention program. Accessed 8 July 2024. www.bcwomens.ca/our-services/population-health-promotion/osteofit.

6.    National Institute on Aging. Four types of exercise can improve your health and physical ability. Accessed 8 July 2024. www.nia.nih.gov/health/exercise-and-physical-activity/four-types-exercise-can-improve-your-health-and-physical.

7.    HealthLink BC. Preventing falls: Exercises for strength and balance. Accessed 8 July 2024. www.healthlinkbc.ca/healthy-eating-physical-activity/age-and-stage/older-adults/preventing-falls-exercises-strength-and.

8.    Wang J, Xu J, An R. Effectiveness of backward walking training on balance performance: A systematic review and meta-analysis. Gait Posture 2019;68:466-475.

9.    Harvard Health Publishing. The best core exercises for older adults. Accessed 8 July 2024. www.health.harvard.edu/staying-healthy/the-best-core-exercises-for-older-adults.

10.    Yeung SSY, Reijnierse EM, Pham VK, et al. Sarcopenia and its association with falls and fractures in older adults: A systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 2019;10:485-500.

11.    Rodrigues F, Domingos C, Monteiro D, Morouço P. A review on aging, sarcopenia, falls, and resistance training in community-dwelling older adults. Int J Environ Res Public Health 2022;19:874.

12.    McKeen K, Wong EM. Sarcopenia in older adults: Use it or lose it. BCMJ 2022;64:359.

13.    Government of Canada. Surveillance report on falls among older adults in Canada. Last modified 20 February 2024. Accessed 8 July 2024. www.canada.ca/en/public-health/services/publications/healthy-living/surveillance-report-falls-older-adults-canada.html.

14.    Fall prevention month. Accessed 18 June 2024. www.fallpreventionmonth.ca.

Eileen M. Wong, MD, CCFP, FCFP, Michael Slatnik, MD, MPH, CCFP. Falls prevention: The lifelong battle against gravity. BCMJ, Vol. 66, No. 8, October, 2024, Page(s) - Council on Health Promotion.


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