Risk of Fall in the Elderly and its Prevention

Risk of Fall in the Elderly and its Prevention

The risk of Falls is the main cause of morbidity and disability in the elderly population, and as a result, they diminish function by causing injury, activity limitations, fear of falling, and loss of mobility. At times, falls become a serious problem and life-threatening and may even cause death.

Falls occur as a result of complex interactions of multiple factors that can directly or indirectly affect health and well-being. Age, gender, and race are non-modifiable risk factors. There may be associated changes with aging, such as a decline in physical, cognitive, and affective capacities and the comorbidities associated with chronic illnesses.

Medication side effects, alcohol abuse, loss of muscle strength, unsafe environments (particularly for those with poor balance and limited vision), improper assistive devices, underlying medical conditions (such as neurological conditions like falls and traumatic brain injury, falls and dementia, orthostatic hypotension, Parkinson’s disease, impaired balance, reduced muscle strength, poor reaction times, and impaired walking patterns), cardiac vascular conditions (such as heart rhythm problems, persons recovering from a stroke, with weakness on one side) or other disabling conditions (such as amputees), sedentary lifestyles, occupations at raised heights or other hazardous working conditions, socioeconomic factors like poverty, overcrowded housing, sole parenthood, and young maternal age are some of the factors that can directly or indirectly affect health and well-being.

Consequence of falls

  • Physical: Skin tears, internal bleeding, subdural hematoma, hip fracture, immobilization/disability, hospitalization.
  • Falls & Fractures: The strongest determinant of a fracture is the actual fall rather than bone fragility. Abnormalities in gait and balance are the most frequent and sensitive risk factors that predispose to fractures. Physical limitations and physical inactivity reduce bone strength and increase fracture risk.
  • Psychological: Fear of falling, increased dependency, depression, confusion, anxiety, loss of confidence, social withdrawal, and loss of autonomy.

Interventions: Multifactorial interventions should include exercise, particularly balance, strength, and gait training, vitamin D supplementation with or without calcium, management of medications, home environment modification, management of postural hypotension, vision problems, foot problems, and footwear. Improving home support by providing opportunities for socialization and encouragement, involving the family, and providing follow-ups. Adequate rehabilitation physically, socially, and psychologically of an injured person is very important post-fall.

Encouraging participation in fall prevention programs and providing information and education plays an important role. Fall prevention programs focus on the important goal of working on the “fear of fall” by addressing the following areas: strengthening, especially the lower limb muscles like the quadriceps which are responsible for locking the knee joint while walking, and avoiding buckling the knee, strong calf muscles that can counteract the displacing force if one loses balance, balance reactions and reaction time. Reaction time and balance are inversely proportional, with poor balance increasing the chances of falls. It is important to identify which balance reaction needs working upon and improve the reaction time.

If flexibility is compromised, then even with good strength and balance reactions, there are chances of Risk of falls because the muscle cannot produce optimal strength when in a shortened position. Similarly, when muscles are overly stretched, they become weak. Endurance means being able to withstand activity for longer periods and depends on an individual’s cardiovascular fitness. After a basic evaluation, physical therapists can chalk out a personalized plan based on the individual’s current fitness and progress it at regular intervals. For ear problems/dizziness, physiotherapists assess dizziness in different positions and prescribe exercises to manage it.

A brief review of the medical history of a senior person should be done to determine his or her general physical condition. A personalized exercise plan which is tailored to the individual’s needs is to be created to improve overall physical function along with the detection of early difficulties with movement, strength, and balance. This enables the identification of the most appropriate risk factors for individuals, as well as determining an individual’s overall risk of falls. Assessment of other causes of falls, such as behavioral and environmental, to pinpoint contributing factors is important in fall prevention.

Written By:
Dr. Snigdha Tiwari
Assistant Professor
Faculty of Physiotherapy
SGT University Gurgaon

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