Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Why Do Older Adults
Fall?
How to Personalize
Fall Prevention
Leslie Kernisan, MD MPH
Better Health While Aging
BetterHealt...
Falls: A Major Problem in Aging
• Over 1 in 4 people aged 65+ fall every year
• 1 in 5 falls results in serious injury
– ...
Why Learn More About Why Older
People Fall?
• Most falls in older adults are “multifactorial”
 multiple risks and factors...
When You Understand What Causes
Falls
• You’ll be better able to work with doctors to:
– Identify YOUR particular fall ris...
Who Benefits Most From Fall
Prevention?
• Research suggests that fall risk assessments
are most likely to help older adult...
What triggers a fall?
Sudden
challenge
to balance
or strength
<
Ability to
stay on our
feet
A fall happens whenever a chal...
Why does a fall happen?
Health-based risks:
Balance problems
Weakness
Vision problems
Chronic diseases
Medications
Environ...
4 Steps to Reduce Your Fall Risk
1. Identify your fall risk factors
2. Identify risk factors and triggers related to
recen...
Step 1: Health-based risks include
• Aging of sensory & blood pressure systems
• Certain types of cardiovascular and neuro...
Step 1: Environmental risks include
• Home hazards:
– Throw rugs
– Poor lighting
– Trip hazards (cords, pets, etc)
• Outsi...
Step 2: Evaluating Falls
• Gather information:
–What triggered the fall? How did the fall
happen?
–Any related symptoms?
–...
Step 2: Evaluating Falls
• Medical evaluation usually includes:
– Underlying new illness
– Blood pressure sitting & standi...
Step 3: Identify modifiable risk factors
• Most falls are due to multiple factors, some
modifiable
• A thorough evaluation...
Step 4: Implement Practical Strategies
to Reduce Falls
• Best to implement strategies that address
your most important and...
Practical Strategies That Help Many
Seniors Reduce Falls
• Exercise & balance training
• Eliminating/reducing certain medi...
Exercise Therapy for Fall Reduction
• Gait, balance, & strength training through
physical therapy
– The Otago program is p...
Exercise Therapy for Fall Reduction
• Tailor a program with your doctor
• Exercises that improve balance are
especially he...
Medications
• Medications are often the most
modifiable factor for fall risk
• Most meds involve a trade-off
• Key is to c...
Eliminating/Reducing Medications
• Most commonly encountered risky meds are:
– Sleeping pills/tranquilizers: Ambien, Ativa...
Other Meds to Consider Reducing
• Blood pressure (BP) medication
– Have BP checked standing & sitting
– If drops, discuss ...
Caution in starting new medications
• A study found that starting blood pressure
medication was associated with 43% higher...
Environmental Modification
• Home safety evaluation
–Often more effective when done by
occupational therapy
• Home modific...
Vitamin D
• Vitamin D supplementation has been shown
to reduce falls, mainly in those with low levels
• Vitamin D helps ma...
My most-used strategies
• Gait and balance training through PT
• Reduce/eliminate risky medications
• Checking blood press...
Other fall prevention strategies that
may apply to you
• Consider addressing:
– Vision issues
– Problems with feet or foot...
Key points to keep in mind
• It’s impossible to prevent all falls
• But we can often reduce a person’s fall risk
• Underst...
Summary
• A person’s fall risk is a combination of multiple
personal and environmental factors
• Understanding your person...
Need More Help with Fall Prevention?
Join me for an online Fall Prevention Workshop!
I’ll help you:
– Identify YOUR most i...
Thank you for your attention!
For more practical tips on better senior
health & helping older parents, visit
BetterHealthW...
Upcoming SlideShare
Loading in …5
×

Why Do Older People Fall? How to Personalize Fall Prevention

60,947 views

Published on

Slides related to the Better Health While Aging article "Fall Prevention: Why Older People Fall & What to Do"
betterhealthwhileaging.net

A geriatrician explains a framework for understanding the factors that cause an older person to fall, and a four-step process for reducing falls.

Family caregivers can use this to learn how to prevent falls in seniors and in aging parents.

Published in: Health & Medicine

Why Do Older People Fall? How to Personalize Fall Prevention

  1. 1. Why Do Older Adults Fall? How to Personalize Fall Prevention Leslie Kernisan, MD MPH Better Health While Aging BetterHealthWhileAging.net
  2. 2. Falls: A Major Problem in Aging • Over 1 in 4 people aged 65+ fall every year • 1 in 5 falls results in serious injury –  800,000 hospitalizations/year due to falls! • Falls cause everything from embarrassment to disability, moving to new home, and even death. • Falls often cause fear of falling in seniors, which can limit activity and quality of life. CDC: Important Facts About Falls BetterHealthWhileAging.net
  3. 3. Why Learn More About Why Older People Fall? • Most falls in older adults are “multifactorial”  multiple risks and factors are making the person vulnerable to falling • The most effective fall prevention plans are personalized.  They identify and target an individual senior’s particular risk factors BetterHealthWhileAging.net
  4. 4. When You Understand What Causes Falls • You’ll be better able to work with doctors to: – Identify YOUR particular fall risk factors – Identify and review your use of medications that may be increasing your fall risk – Develop a personalized fall prevention plan tailored to YOUR particular risks BetterHealthWhileAging.net
  5. 5. Who Benefits Most From Fall Prevention? • Research suggests that fall risk assessments are most likely to help older adults who report one or more of the following: – Have fallen in the previous year – Are experiencing fear of falling – Are having difficulty with walking or balance – Have been seen by doctors after a fall BetterHealthWhileAging.net
  6. 6. What triggers a fall? Sudden challenge to balance or strength < Ability to stay on our feet A fall happens whenever a challenge to balance overwhelms our current ability to stay upright BetterHealthWhileAging.net
  7. 7. Why does a fall happen? Health-based risks: Balance problems Weakness Vision problems Chronic diseases Medications Environmental risks: Home hazards Outside hazards Poor footwear + Trigger: Tripping Stumbling New illness Dizzy spell Overexertion Alcohol = fall BetterHealthWhileAging.net
  8. 8. 4 Steps to Reduce Your Fall Risk 1. Identify your fall risk factors 2. Identify risk factors and triggers related to recent or recurrent falls 3. Focus on modifiable risk factors 4. Implement practical strategies to reduce risk, tailored to your preferences & individual circumstances BetterHealthWhileAging.net
  9. 9. Step 1: Health-based risks include • Aging of sensory & blood pressure systems • Certain types of cardiovascular and neurological disease • Arthritis • Anemia • Weakness (esp in lower legs) • Vision problems • Cognitive impairment and dementia • Many commonly used medications BetterHealthWhileAging.net
  10. 10. Step 1: Environmental risks include • Home hazards: – Throw rugs – Poor lighting – Trip hazards (cords, pets, etc) • Outside hazards – Uneven or slippery surfaces • Footwear – High heels; thick or slippery soles • Improper use of assistive devices BetterHealthWhileAging.net
  11. 11. Step 2: Evaluating Falls • Gather information: –What triggered the fall? How did the fall happen? –Any related symptoms? –Pattern of falls? –Any changes since the fall? –Medications (highlight new/changed drugs) BetterHealthWhileAging.net
  12. 12. Step 2: Evaluating Falls • Medical evaluation usually includes: – Underlying new illness – Blood pressure sitting & standing – Bloodwork – Walking and balance assessment – Evaluation for underlying cardiovascular or neurological disease • Consider vision and foot exams BetterHealthWhileAging.net
  13. 13. Step 3: Identify modifiable risk factors • Most falls are due to multiple factors, some modifiable • A thorough evaluation for all modifiable factors often takes more than one visit – Multidisciplinary teams are helpful • Ask the doctor to explain all factors contributing to the falls • Then ask for the plan to address each factor BetterHealthWhileAging.net
  14. 14. Step 4: Implement Practical Strategies to Reduce Falls • Best to implement strategies that address your most important and modifiable risk factors  Learn from past falls and near-falls  Address those health-based risks, environmental risks, and triggers that you can • Certain fall prevention strategies do tend to help most older adults, because they address very common fall risk factors BetterHealthWhileAging.net
  15. 15. Practical Strategies That Help Many Seniors Reduce Falls • Exercise & balance training • Eliminating/reducing certain medications • Caution in starting certain medications • Environmental modification • Vitamin D supplementation BetterHealthWhileAging.net
  16. 16. Exercise Therapy for Fall Reduction • Gait, balance, & strength training through physical therapy – The Otago program is proven and recommended by the Centers for Disease Control • Movement activities – Tai Chi, dance, yoga • General physical activity – Helpful but usually is not a substitute for focused activities to address strength, balance, and flexibility BetterHealthWhileAging.net
  17. 17. Exercise Therapy for Fall Reduction • Tailor a program with your doctor • Exercises that improve balance are especially helpful • Combine the 4 types of exercise older adults need – Strength, balance, flexibility, endurance BetterHealthWhileAging.net
  18. 18. Medications • Medications are often the most modifiable factor for fall risk • Most meds involve a trade-off • Key is to clarify benefits vs risks • Lower doses may provide benefit with lower risk BetterHealthWhileAging.net
  19. 19. Eliminating/Reducing Medications • Most commonly encountered risky meds are: – Sleeping pills/tranquilizers: Ambien, Ativan – “Anticholinergics”, which include drugs for: • Sedating antihistamines (Benadryl) • Over-the-counter sleep aids (all PM analgesics) • Overactive bladder drugs (Ditropan, Detrol) • Muscle relaxants (Flexaril) –The CDC’s guidance for clinicians is here. BetterHealthWhileAging.net
  20. 20. Other Meds to Consider Reducing • Blood pressure (BP) medication – Have BP checked standing & sitting – If drops, discuss reduction in BP medications – Note that Flomax (for urination) also causes this drop • Diabetes medications – Insulin and diabetes drugs may need to be reduced in those experiencing low blood sugar BetterHealthWhileAging.net
  21. 21. Caution in starting new medications • A study found that starting blood pressure medication was associated with 43% higher risk of hip fracture! • Start low, go slow –Ask doctor to start at lowest possible dose, for any medication that can affect blood pressure, balance, or thinking BetterHealthWhileAging.net
  22. 22. Environmental Modification • Home safety evaluation –Often more effective when done by occupational therapy • Home modification –Remove throw rugs and trip hazards –Ensure well-lit path to bathroom at night –Grab bars in the shower or bath –Ensure adequate handrails for stairs BetterHealthWhileAging.net
  23. 23. Vitamin D • Vitamin D supplementation has been shown to reduce falls, mainly in those with low levels • Vitamin D helps maintain bones and muscles • Most older adults should take 800-1000 units of vitamin D every day – See Vitamin D: the Healthy Aging Dose to Prevent Deficiency & FAQs • Those with very low levels may need higher doses (check with your doctor) BetterHealthWhileAging.net
  24. 24. My most-used strategies • Gait and balance training through PT • Reduce/eliminate risky medications • Checking blood pressure sitting/standing & minimizing drops when standing • Encourage safe exercise • Common-sense home modifications • Vitamin D 800-1000 units daily BetterHealthWhileAging.net
  25. 25. Other fall prevention strategies that may apply to you • Consider addressing: – Vision issues – Problems with feet or footwear – Arthritis management – Evaluating and addressing frequent pain, especially in feet/legs/back – Anemia – Vertigo – Certain chronic cardiac or neurological diseases – Optimizing use of assistive devices BetterHealthWhileAging.net
  26. 26. Key points to keep in mind • It’s impossible to prevent all falls • But we can often reduce a person’s fall risk • Understanding your risk factors can help you be proactive • Individualized assessment and a personalized plan are best • Your doctors may need gentle reminders in order to help you reduce your risk BetterHealthWhileAging.net
  27. 27. Summary • A person’s fall risk is a combination of multiple personal and environmental factors • Understanding your personal risk factors is key • Work on modifying what you can, especially medications • Exercise and balance training are great • Ask your doctor for help if you’ve been falling, or are afraid of falling BetterHealthWhileAging.net
  28. 28. Need More Help with Fall Prevention? Join me for an online Fall Prevention Workshop! I’ll help you: – Identify YOUR most important fall risk factors and triggers – Create a next steps action plan that you can discuss with your health providers Click here to learn more about the Fall Prevention Workshop! BetterHealthWhileAging.net
  29. 29. Thank you for your attention! For more practical tips on better senior health & helping older parents, visit BetterHealthWhileAging.net

×