Fall prevention in older adults

Fall Prevention: Cause and Risk Factors In Older Adults

• Falls occur due to an underlying cause or risk factor
• Falls are linked to the physical condition and/or a medical problem
• Normal ageing brings physical, cognitive and affective changes that may contribute to falls
• Such change seclude sensory, metabolic, neurological and musculoskeletal changes
• Falls are more prevalent in females than males
• Frailty, immobility and acute and chronic health conditions are markers for falls
• Falls diminish function by causing injury, limiting activity, losing mobility and increasing the fear of falling
• Serious injuries include fractures of the hip, wrist, humerus, and pelvis and often are a combination of a fall and osteoporosis
• Falls can also be caused by loss of consciousness, stroke, heart attack, vertigo or an external blow
• Environmental factors must not be disregarded – trip hazards, inappropriate stairway design, wet slippery surfaces, clutter, poor lighting etc.

Risk Factors

• Muscle weakness – in particular legs- not just strength but also endurance and flexibility
• Balance and/or gait – lack of activity, neurological cause, arthritis or other bone or tissue disease
• Changes in blood pressure – postural hypotension when changing body positions, dehydration, types of medication, neurological disorders like Parkinson’s, infection and even diabetes
• Postural hypotension is often accompanied by dizziness
• Slow reflex times – with slow reaction time if they trip they are likely to fall
• Painful feet and wrong footwear – slippers, high heels, and smooth-soled shoes can all contribute to a fall
• Sensory problems – numbness in peripheries like feet. Secure contact with foot placement is compromised
• Vision problems – issues with depth perception and poor awareness of surroundings. Glaucoma, cataracts, macular degeneration and multifocal glasses all contribute to poor environmental perception
• Mental confusion
• Medications – multiple medications are more likely to cause issues.

Falls Risk Screening

Stay On Your Feet Program

For Health Professionals

• A falls risk assessment is available – FROP
• Physiological profile assessment – PPA
• Examples of screening tools
• 6-metre walk – gait speed
• Alternative step test – time and coordination
• Elderly Fall Screening test (EFST) – 5 items – low/high risk, based on fall history, walking speed and gait style.

Examples of Screening Tools

• Falls Efficacy Scale – International (FES-I)– assesses fear of falling during normal daily activities
• Falls Risk for Older People in the Community ( FROP-Com Screen) – 3 item test to determine those at greatest risk of future falls
• Functional Reach – balance measure by assessing the difference between a person’s arm length and their maximum reach forward
• Sit to stand test – lower limb strength
• Timed up and go – leg strength, gait speed, agility.

Berg Balance Scale

• Developed to measure balance among older people with an impairment in balance function by assessing their performance in functional tasks
• Used in clinical practice and research
• 14 item scale which provides a risk stratification to assist with intervention strategies.

Heath Issues Needing GP Investigation

• Vasovagal syncope – fainting
• Orthostatic hypotension – drop in blood pressure when standing from sitting or lying positions
• Carotid sinus hypersensitivity – mechanical forces like head-turning or looking up result in greater than expected changes in heart rate and blood pressure drop.
• Cardiac arrhythmias – age can cause deterioration of the heart’s electrical conduction system
• Dizziness/ vertigo – vestibular disorders (ears).