Falls often mark the beginning of a deadly downward spiral in the health of seniors. Tripping over a rug, falling down stairs or slipping on ice can lead to broken hips, serious head injuries and numerous other health problems that can immobilize the elderly and hasten their deaths.
Nearly all people age 65 and older will fall at least once a year. Thousands die from the injuries, while countless others languish in hospitals or nursing homes, where the lack of mobility puts them at risk of developing pneumonia and other potentially fatal complications. Falls cost the health-care system nearly $3-billion every year, according to the Public Health Agency of Canada.
It doesn’t have to be this way.
Falls are not an inevitable part of aging, and medical experts from across Canada are pushing patients, the health-care system and policy-makers to recognize the importance of prevention.
“That’s the main challenge we have, is integrating fall prevention into everyday practice for everybody that works with older adults,” said Vicky Scott, clinical associate professor at the University of British Columbia and senior adviser on fall and injury prevention for the B.C. government.
They’ve had marginal success so far: Fall prevention programs are in place at many hospitals, health-care facilities and homes across Canada. Hip protectors, similar in appearance to cycling shorts and designed to protect the hips when a fall occurs, are becoming increasingly common. Experts have also created the Canadian Falls Prevention Curriculum, designed to teach those working with older people about the best techniques and strategies for reducing risks.
But much more needs to be done, experts say. In addition to reducing hazards in the home and discussing strategies with seniors, advancements in research and technological developments have led to the creation of new and important prevention measures and everyone, from doctors to pharmacists to patients themselves, has a potential role to play.
One of the best ways for seniors to avoid falls is to be active and do targeted exercises geared toward their level of physical fitness. Research shows that 50 per cent of falls can be reduced through strength and balance training, according to Karim Khan, leader of fracture prevention at the Centre for Hip Health and Mobility, a Vancouver-based research institute focused on arthritis and hip-related fractures.
But Dr. Scott warns that not all forms of exercise may be appropriate, and could even lead to problems. “When you talk about frail people you have to be really careful,” she said.
Exercise must be progressive and must push a person physically, but still be tailored to individual needs and limits. Sitting exercises don’t help prevent falls, nor do pool-based exercises, Dr. Scott said. But Tai Chi has been shown to have numerous benefits.
New guidelines published by the American Geriatrics Society and the British Geriatric Society this year recommend all fall-prevention strategies include an exercise component to improve balance, gait and strength, such as physical therapy or Tai Chi.
Diet, drugs and nutrition
As any older person knows, the amount of prescription drugs a person must take typically increases with age. But they might not realize medications could put them at an increased risk for falling. Drugs, particularly those used to treat anxiety, sleeplessness or depression, can cause dizziness, affectjudgment or result in blood pressure changes that can make a person more likely to fall. At the same time, many elderly people may not be getting the right nutrition or enough water, which research also shows increases the chances of falls.
Prevention experts say that doctors, pharmacists, family members and the elderly need to be vigilant about checking for changes in balance or steadiness, which may indicate prescription drugs are putting an individual at risk. They also need to ensure seniors are consuming a healthy diet as well as consuming supplements known to increase bone health, such as vitamin D and calcium. (Although recent studies have raised questions about a link between too much calcium and risks to the heart, the evidence isn’t yet clear enough to change policy recommendations).
Although seniors likely know their home better than anywhere else, about half of all falls occur in and around the house. This could be for a variety of reasons: declining eyesight, chronic illnesses, such as arthritis, infections or other illnesses, weakness or other problems, such as depression or dementia. Instead of waiting for a senior to fall before action is taken, a growing number of experts argue that pro-active steps around the home, ranging from removing low furniture to installing grab bars in bathrooms, can help prevent tragedy. But seniors are also responsible for recognizing they’re not the same person they used to be and may not be able to climb ladders or go skiing anymore.
Dealing with the fall
If seniors do fall, steps need to be taken to help their recovery or prevent it from happening again. Doctors need to be notified of falls, even if an individual doesn’t suffer an injury, Dr. Scott said. Similarly, doctors should be questioning elderly patients about their balance and whether they have fallen.
When an elderly person does suffer a fall-related fracture or other injury, they should receive physical therapy or the appropriate rehabilitative support to help them regain mobility and reduce the loss of muscle mass and strength. Famida Jiwa, president and CEO of Osteoporosis Canada, highlights the importance of post-fracture care, which involves assessing an individual in hospital to determine how future breaks can be prevented.
The basic message is that while a fall can be detrimental, with proper care and attention, it doesn’t have to mean the end of the world.
“If we’re truly looking to revamp the health-care system, there needs to be post-fracture care intervention,” Dr. Jiwa said. “If we are able to prevent the second break, from a policy perspective, it would seem a high return on investment.”