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Fall prevention in older adults

This article looks at fall prevention in older adults due to an underlying cause or risk factor, and the process of falls and risk screening.
older adult lifting weights
© CQUniversity 2021

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

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).

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

© CQUniversity 2021
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