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Why Do Older People Fall? How to Personalize Fall Prevention


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

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
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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
  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
  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 older adult’s particular risk factors
  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
  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
  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
  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
  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
  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
  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
  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)
  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
  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
  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
  15. 15. Practical Strategies That Help Many Older Adults Reduce Falls • Exercise & balance training • Eliminating/reducing certain medications • Caution in starting certain medications • Environmental modification • Vitamin D supplementation
  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
  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
  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
  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.
  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 • My list: 10 Types of Medication to Review if You’re Concerned About Falling.
  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
  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
  23. 23. Vitamin D • Vitamin D supplementation was thought to reduce falls risk but the scientific evidence has been underwhelming – May help in those with very low levels • Vitamin D does maintain bones and muscles • Most older adults should take 800-1000 units of vitamin D every day, to avoid deficiency – See Vitamin D: the Healthy Aging Dose to Prevent Deficiency & FAQs • Those with very low levels may need higher doses (check with your doctor)
  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
  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 – Vitamin D
  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
  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
  28. 28. For More on Fall Prevention • CDC STEADI website covers just what health providers should be doing, to help you address falls – • BHWA Falls Topic page – – Or consider the Fall Prevention Mini Course for more; includes worksheets to help you identify issues to discuss with your health providers.
  29. 29. Thank you for your attention! For more practical tips on better aging health & helping older parents, join our community at