Preventing Falls in the Elderly

Preventing Falls in the Elderly Natalie StJohn University of Arkansas Community College at Batesville.
As health care becomes more sophisticated and better, other concerns are starting to surface. Such interests that started as mere nuisances are now becoming the focal point of involvement that aims to correct and improve the welfare of individuals. One such clinical concern is the phenomenon of falls, especially with the older population. Falling in elderly individuals is a significant, yet under-recognized and underestimated public health concern (Woolcott et al. , 2009). About 30% of people over 65 years old and living in their respective communities fall annually, with such figures even higher in health institutions, and about a fifth of such incidents require medical attention (Gillespie, Gillespie, Robertson, Lamb, Cumming, & Rowe, 2009). In a one-year follow-up study of persons aged 75 years and above living in the community, about one-third reported at least one incident of fall (Tinetti, Speechley, & Ginter, 1988), with a higher annual fall risk of up to 50%, occurred in the oldest population or with the individuals living in nursing homes, with the consequences of injuries and fractures because of falls (like mortality, hospitalization, disability, and institutionalization) rise as with the age (Berdot et al. , 2009).
The estimated costs associated with falls and fall-related complications are at billions of dollars worldwide (Scuffham, Chaplin, & Legood, 2003; Lewin Group, 2000; Smartrisk Foundation, 2009). Hence, research regarding the factors why elder people fall becomes all the more necessary (Woolcott et al. , 2009).  There are several reasons why people fall. Fall risk is multifactorial in nature, with risk factors being intrinsic and extrinsic (Graafmans et al. , 1996). The most common reasons are uncontrolled hypertension, orthostatic hypotension, and use or inappropriate use of certain medications (Gangavati et al. 2011); Woolcott et al. , 2009; Bardot et al. , 2009).

With regards to hypertension and systolic orthostatic hypertension, older individuals suffering from such conditions are at greater risk for falls within a year (Gangavatti et al. , 2011). The study also noted that older patients with their hypertension controlled have no effect with regards to falls (Gangavatti et al. , 2011). The older populations with the increased use of antidepressants, benzodiazepines, hypnotics, and sedatives have a larger and increase the chances of falls with elderly persons (Woolcott et al. 2009). This marked increase is mostly due to the long-lasting effects of benzodiazepines as well as inappropriate psychotropics, and since these medications have anticholinergic properties (Berdot et al. , 2009).  There are several ways to mitigate, lessen, or even prevent the chances of the elder population from falling. Interventions with multidisciplinary properties are proven effective in minimizing fall incidents, as well as muscle-strengthening balance retraining prescribed at home and assisted by a trained health professional (Gillespie et al. 2009).
Tai Chi is also another effective alternative intervention for mitigating falls (Gillespie et al. , 2009). For those with a history of falling, home hazard assessment, and modification by a healthcare professional could also minimize the chances of falls (Gillespie et al. , 2009). Cardiac pacing for individuals with a high risk of falls due to cardio-inhibitory carotid sinus hypersensitivity also has a high chance of being beneficial, as is the withdrawal of psychotropic medications (Gillespie et al. , 2009). Studies have also shown that individually tailored interventions delivered by healthcare professionals are more effective than standard or group delivered programs (Gillespie et al. , 2009). Falls is a highly preventable, yet still highly prevalent cause of injury and even mortality with the elderly. The abovementioned interventions could help in minimizing its detrimental effects.

Berdot, S. , Bertrand, M. , Dartigues, J. F. , Fourrier, A. , Tavernier, B. , Ritchie, K. , & Alperovitch, A. , (2009)
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Estimated savings from falls prevented by targeted home modifications. Washington, DC: AARP Public Policy Institute. Gangavati, A., Hajjar, I., Quach, L., Jones, R., Kiely, D., Gagnon, P., & Lipsitz, L. (2011).
Hypertension, Orthostatic Hypotension, and the Risk of Falls in a Community-Dwelling Elderly Population: The Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston Study. Journal of American Geriatric Society, 59(3), 383-389. DOI:  10. 1111/j. 1532-5415. 2011. 03317. x Gillespie, L. D., Gillespie, W. J., Robertson, M.
C., Lamb, S. E., Cumming, R. G., & Rowe, B. H. (2009).
Interventions for preventing falls in elderly people. Cochrane Database of Systematic Reviews, (4). DOI: 10. 1002/14651858. CD000340. Graafmans, WC. , Ooms, M. E., Hofstee, H. M., Bezemer, P. D., Bouter, L. M., & Lips, P. (1996).
Falls in the elderly: a prospective study of risk factors and risk profiles. American Journal of Epidemiology, 143(11), 1129- 1136. Scuffham P., Chaplin, S., & Legood, R. (2003).
Incidence and costs of unintentional falls in older people in the United Kingdom. Journal of Epidemiology and Community Health, 57(9) 740- 744. Smart risk Foundation. (2009).
The Economic Burden of Unintentional Injury in Canada. Smart risk Foundation Website. Retrieved from HTML. Accessed October 20, 2012.
Tinetti ME, Speechley M, Ginter SF, (1988). Risk Factors for Falls among Elderly Persons Living in the Community. New England Journal of Medicine, 319,1701-1707. Woolcot, J., Richardson, K., Wiens, M., Patel, B., Marin, J., Khan, K., & Marra, C. (2009).
A meta-analysis of the impact of 9 Medication Classes on Falls in Elderly Persons. Archives of Internal Medicine, 169(21), 1952-1960. doi:10. 1001/archinternmed. 2009. 357.

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