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| EDITORIAL |
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| Year : 2022 | Volume
: 18
| Issue : 1 | Page : 1-2 |
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Prevention of falls
S Deepa
Associate Professor of Geriatric Medicine, Government Mohan Kumaramangalam Medical College, Salem, Tamil Nadu, India
| Date of Web Publication | 21-Apr-2022 |
Correspondence Address:
Dr. S Deepa
Associate Professor of Geriatric Medicine, Government Mohan Kumaramangalam Medical College, Salem, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/0974-3405.343686
How to cite this article:
Deepa S. Prevention of falls. J Indian Acad Geriatr 2022;18:1-2 |
New Year Greetings!
Indeed, it is a privilege to write the Editorial of the first issue of JIAG of this year. Falls are a major public health issue in the elderly and the fifth leading cause of death in the elderly. Therefore, the Editorial has chosen to highlight the need to prevent falls and fall-related injuries.
Falls is defined as an unintentional event in which a person comes to rest on the ground, floor, or other lower level. Falls are common among older people. Approximately one-third of the community-dwelling older people aged 65 and above fall annually, and about one-fourth of them have a recurrent fall. The incidence of falls is three times higher in hospitals and skilled nursing homes.
Although people of all ages fall, we are more bothered about the falls in the elderly because of the consequences of falls such as soft tissue injuries, head injury, fracture, emergency admission, and hospitalization. In addition, it may lead to fear of falling, loss of physical function, dependence, and decreased quality of life in the elderly.
Like any other geriatric syndrome, falls are due to multiple interacting risk factors in an individual with reduced tolerance to external stress. The most important risk factors of falls are advanced age, female sex, previous history of fall, fear of fall, inactivity, living alone, limitations in activities of daily living, deficits in gait and balance, visual deficits, cognitive impairment, depression, drugs, and environmental factors.
The American Geriatrics Society and the British Geriatrics Society Clinical Practice Guideline for Preventing Falls in Older Persons recommend that older people aged 65 and above be screened for falls annually as they do not report the previous falls.[1] The screening starts with simple questions, “How many falls did you have in the previous year?” and “Do you have difficulty in gait and balance?” This screening will help us in identifying high-risk patients. The high-risk patients include those with a history of ≥2 falls in the previous year, those with emergency admission for a fall, or those with gait and balance problems.
CDC's injury center has created a fall prevention initiative called Stopping Elderly Accidents, Deaths, and Injuries (STEADI). The STEADI initiative offers a coordinated approach to implement the American Geriatrics Society and the British Geriatrics Society Clinical Practice Guidelines for Preventing Falls in Older Persons.[2] It consists of three components - screening patients for fall risk, assessing modifiable risk factors, and intervention to reduce the risk using effective clinical and community strategies.
Multifactorial assessment and management are recommended for high-risk patients.[1],[3],[4] A person-centered fall risk assessment should be done, and a care plan involving the patient and the caregiver should be devised.
The early step in the evaluation is the assessment of gait, balance, and muscle strength.[3] There are many standard assessment methods such as timed up and go test, functional reach test, performance-oriented mobility assessment, Berg balance test, and short physical performance battery. One of these validated tests can be followed to assess gait, balance, and muscle strength.
Evidence from systematic reviews shows that exercise reduces the risk of falls.[5] Multimodal exercise program comprising flexibility exercises, strengthening exercises, and balance training tailored to the need and capacity of older people is recommended. Yoga and Tai chi can improve balance and help prevent falls. The exercise program may be a home-based, outpatient-based, or community-based program. The results of systematic reviews regarding the role of Vitamin D in the prevention of falls are inconsistent. Hence, prescribing Vitamin D to prevent falls is not recommended.[4]
The use of multiple drugs and specific classes of drugs is associated with an increased risk of falls. As the number of drugs increases, the chance of fall also increases. Drugs that can cause falls include antihypertensives, diuretics, sedatives, antidepressants, and antipsychotics.[6],[7] Review the medications and assess the risks and benefits of the given drugs. Dose reduction or discontinuation of the drug may be necessary to prevent falls.
Vision is important for mobility and functional independence. Visual impairment is yet another risk factor for falls. The beneficial effect of cataract surgery in preventing falls has been studied in many trials.[8] Bifocal glasses blur the ground-level hazards. Hence, unifocal glasses are advised for outdoor use in older people.
Cognitive impairment and depression and the drugs used to treat these conditions are risk factors for falls. An original article has assessed the risk factors for falls in older adults with cognitive impairment in the current issue. In this study, the authors have found that gender, body mass index, socioeconomic status, number of comorbidities, depression and impairment in-home, and hobbies domain of clinical dementia rating scale are independent risk factors for falls in older people with cognitive impairment. A systematic review by Sherrington et al. found that exercise as a single intervention can prevent a fall in people with cognitive impairment and Parkinson's disease.[5]
Orthostatic hypotension and cardiovascular causes such as carotid sinus hypersensitivity and arrhythmias can cause syncope and falls in older people and are to be managed appropriately to prevent a fall.
The environmental risk factors for falls include uneven or slippery surfaces, poor lighting, clutter in the pathways, and low furniture. In addition, ill-fitting footwear can impair balance and increase the risk of falls. Therefore, home modification, correct footwear, and use of the appropriate assistive devices are advised if needed.
Evidence from randomized control trials shows that single intervention strategies such as exercise, expedited cataract extraction, withdrawal of psychotropic medication, cardiac pacing for carotid sinus hypersensitivity, foot care, and home safety intervention are effective in the prevention of falls. Multifactorial fall prevention strategies are recommended for high-risk patients, and it involves multidisciplinary team.[1],[3],[4]
Falls and fall-related injuries are a major threat to older people's health and functional independence. Therefore, educating and creating awareness about fall and fall prevention strategies among the elderly and their caregivers must be a part of any fall intervention program.[1] Health-care providers, older people, and caregivers can work together to reduce the risk of falling in older people.
| References | |  |
| 1. | Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society. Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc 2011;59:148-57.  |
| 2. | |
| 3. | Ganz DA, Latham NK. Prevention of Falls in Community-Dwelling Older Adults. N Engl J Med 2020;382:734-43. |
| 4. | Grossman DC, Curry SJ, Owens DK, Barry MJ, Caughey AB, Davidson KW, et al. Interventions to Prevent Falls in Community-Dwelling Older Adults: US Preventive Services Task Force Recommendation Statement. JAMA 2018;319:1696-704. |
| 5. | Sherrington C, Michaleff ZA, Fairhall N, Paul SS, Tiedemann A, Whitney J, et al. Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. Br J Sports Med 2017;51:1750-8. |
| 6. | de Vries M, Seppala LJ, Daams JG, van de Glind EM, Masud T, van der Velde N; et al. Fall-Risk-Increasing Drugs: A Systematic Review and Meta-Analysis: I. Cardiovascular Drugs. J Am Med Dir Assoc 2018;19:371.e1-371.e9. |
| 7. | Seppala LJ, Wermelink AM, de Vries M, Ploegmakers KJ, van de Glind EM, Daams JG, et al. Fall-Risk-Increasing Drugs: A Systematic Review and Meta-Analysis: II. Psychotropics. J Am Med Dir Assoc 2018;19:371.e11-371.e17. |
| 8. | Harwood RH, Foss AJ, Osborn F, Gregson RM, Zaman A, Masud T. Falls and health status in elderly women following first eye cataract surgery: A randomised controlled trial. Br J Ophthalmol 2005;89:53-9. |
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