According to research findings published by the Center for Disease Control and Prevention (CDC), the death rate resulting from falls has been on a steady rise in the USA. If urgent mitigation measures are not put in place, it is projected that an estimated 7 lives will be lost every hour by 2030. The report also indicates that about 60% of the elderly people in nursing homes and another 35% living in the community fall on a regular basis. Falls in the elderly population are typically associated with age-related complications like seizures or environmental tripping hazards like loose carpets or stacks of newspapers. The Center for Disease Control and Prevention (CDC) lists falls as the number one cause of injuries among seniors. As statistics would have it, over 30% of all falls in the elderly causes a minor injury while another 10% result in major injuries such as bone fractures and head injuries which accounts for 95% of all hip fractures among the elderly. Bone fractures and head injuries have been listed as major causes of traumatic brain injury (TBI).
While this kind of data can make us all apprehensive about our loved ones, the good news is that falls are actually preventable. Let’s look at the major causes of falls in detail.
Causes of Falls in the Elderly
Because the prevention of falls among the elderly is of critical priority, it is important first to identify factors or situations that cause falls. This way, it will be possible to address the risk factors comprehensively so that the aging population can live in a safe environment.
- Osteoporosis. Osteoporosis refers to the thinning or weakening of the bones. It is among the major causes of bone fractures among seniors. Osteoporosis has been linked to hip, spine, wrists and arm fractures.
- The weakening of the muscles or slow reaction to a fall. Lower limb weakness that comes as a result of aging is also a major cause of falls.
- Visual impairment is a condition associated with aging. With some seniors unable to watch their steps due to poor eyesight, falling becomes inevitable. Some age-related eyesight conditions include cataracts, glaucoma, and macular degeneration.
- A continued decline in functional and cognitive ability, e.g. dementia.
- Gait and balance disorders. These are attributed to factors like arthritis, Parkinson’s disease, neuromuscular disease, or orthostatic hypertension.
- Polypharmacy. Polypharmacy refers to a situation in which an individual is using several medications simultaneously. This can cause side effects such as dizziness or drowsiness and result in a fall.
- Acute conditions, such as low blood pressure and cardiovascular diseases, e.g. valvular heart disease or cardiac arrhythmias.
- Environmental hazards. Anything cluttered around their paths is bound to become a risk of falls in the elderly. Other factors include poor visibility/ poor lighting and lack of railings and handlebars in stairs or bathrooms.
- Steep stairs without proper handrails. Stairs with high risers and slippery surfaces pose the highest risk of falls among seniors.
- Lack of walking frames or sticks as well as unavailability of grab bars in bathrooms. Ensure adequate supply or proper installation in vulnerable places to minimize falls.
- Clothes that are baggy due to loss of weight or footwear with slippery soles. Seniors should wear fitting clothes and light shoes with ribbed/ rubber soles for proper traction.
Fall Prevention Strategies in Aged-care
Once the risk factors have been identified, the problem is half solved. However, addressing this risk factors may sometimes not be within our DIY power. Here it is important to work with a reliable professional who has the best interest of your aging parents at heart. This is because with age people become overly sensitive and delicate so they will need to be handled with a lot of care.
Strength and balance training
As we age, we tend to limit our physical activities in an attempt to limit the chances of anything going wrong. While this might be true, studies have shown that accelerated muscle loss in the elderly is caused by lack of exercises. As a remedy, seniors should be enrolled in a fall prevention exercises program such as Tai Chi, which has proven to be helpful in regaining balance and lower limb strength.
A review of medications
Polypharmacy can have adverse side effects in the elderly. These include such effects as drowsiness and decreased reflexes. Drugs that have been known to increase the risk of falls in the elderly include antidepressants, sedatives, hypnotics, and antipsychotics. While these medications might be necessary at this stage, reviewing them regularly with a view of stopping unnecessary use will be essential. It is worth noting that the drugs need to be withdrawn gradually so that these people will not encounter any difficulties and then force a restart. Studies indicate withdrawing sedatives and hypnotics, a remedy for insomnia, to be the most difficult. To prevent addiction, these medications should be prescribed in the lowest effective dose possible and for a limited period of time. Alternative remedies like sleep compression and safer drugs with minimal side effects are recommended.
Vitamin D supplements
The dramatic loss of bone and muscle has been linked to low hydroxyvitamin D concentration among seniors. A study conducted by the U.S. Preventive Services suggests that doses of 700-1000 IU a day will help reduce falls in seniors. A higher dose may not be prescribed unless otherwise recommended by a physician or if the deficiency levels are found to be critically low. Vitamin D supplement is amazingly effective in improving bone density and muscle function.
Seniors who have undergone corrective surgery for conditions such as cataracts are less susceptible to falls. Ophthalmology treatment should help address age-related visual impairments such as altered depth perception and poor distance vision. Eyeglasses not only improve vision but also sorts the issue of depth perception.
There are several recommendations that senior care advocate for in fall prevention education. Most obvious ones include removing the clutter, installing grab bars and handrails in stairways as well as keeping all rooms well-lit and these cannot be overemphasized. The elderly should wear well-fitting clothes and non-slippery footwear. Other modifications include non-slippery floors in the bathroom and kitchen. To further address fall prevention at home in the elderly, reserve them a room in the ground floor thus eliminating the falling hazard posed by stairs.
Fall Prevention in the Elderly Checklist
Fall prevention posters and fall prevention handouts from care experts can help you evaluate the safety of your home. Contained in the checklist are the following recommendations:
- Make sure there are no loose carpets.
- Install handrails on all staircases.
- Have non-slippery floors.
- Remove all tripping hazards/clutter, e.g. shoes and loose cables in areas where the elderly regularly walk.
- Have chairs of the right height, i.e. the elderly should sit or get out of it without straining.
- Ensure there is adequate lighting in the room.
- Have a flashlight ready in case of any power outage.
- Get rid of any loose throw rugs.
- Make sure there are no broken or uneven stairs.
- Have light switches that glow all the way from the bottom to the top of the stairs.
- Place heavy and frequently used items on low shelves/cabinet.
- Never use a chair as a step stool. Invest in a steady step stool, preferably with a bar at the top.
- Avoid overstretching. Overstretching not only puts a strain on your muscles, it can also make you lose balance.
- Avoid wet/slippery floors.
- Install grab bars for support when getting in and out of the tub or standing up from a toilet seat.
- Put non-slippery mats on the floor of the tub.
- Install nightlights to aid in night visits.
- Get rid of all soap buildup to avoid slipping.
- Install a raised toilet seat.
- Use rubber mats.
- Trim shrubs and bushes along the paths.
- Install handrails on stairs and steps.
- Have adequate lighting on doorways/ along the paths in case of evening strolls.
- Ensure the path has no loose surface/objects that can pose a problem.
- Have reflecting colors or tape on doors or curbs.
- Install nightlights so you don’t crash into objects while moving at night.
- De-clutter the room.
- Have a lamp within reach.
More information on how to make the home more secure for your elderly loved ones is in our “Safety Checklist for the Elderly” article.
Hip Fracture Risk Factors
Major risk factors associated with hip fractures in the elderly are directly related to bone and muscle loss. Others include:
- Age. It is not surprising that there is a direct correlation between age and hip fractures. According to research done by the National Hospital Research Survey (NHRS), 80% of the people hospitalized for hip fractures were above 60 years.
- Gender. Interestingly, women are more susceptible to hip fractures than men. An estimated 70% of all hip fractures among the elderly occur among women.
- Heredity. Genetics can put you at a greater risk of having a hip fracture. If your family background has had a history of Osteoporosis, then you’re at a greater risk of succumbing to a hip injury at one point or the other. Also included in this category are the thinly built individuals. Consult your doctor concerning the right medications that can slow bone loss and increase muscle strength.
- Nutrition. Poor eating habits (malnutrition) and low body weight put one at a greater risk of hip fracture. A senior’s diet should, therefore, include high calcium content and plenty of Vitamin D. Always maintain a healthy body weight. Ideally, elderly women (over 50 years) and men over 70 years should take at least 1200 mg of calcium per day. Vitamin D goes hand in hand with calcium, so the elderly under 70 years should take in 600 IU a day while over 70 are required to take at least 800 IU. Also, include potassium-rich fruits and vegetables in their diet.
- Lifestyle. This includes a lack of exercises and use of alcohol. Alcohol causes one to lose balance and heightens the chances of falling. Regular exercises will help one maintain much of their balance, thereby reducing incidences of falls. If you’re serious about fracture prevention, stop smoking and check your alcohol intake.
- Other factors include poor eyesight (you can get into a ditch), and medical conditions such as epilepsy or Parkinson’s disease.
Hip Fracture Prevention
A hip fracture is a serious injury among the elderly. Depending on the type of fracture, one can experience a lot of pain in the upper thigh or groin. When this happens, make a point of visiting the doctor as soon as you can, in order to establish the type of fracture and the best treatment for it.
Treatment might involve a surgical operation if there is complete breakage or be non-surgical for “stable” fractures. Even though we have made enough technological advancements to address any type of fracture, recovery is usually painful, extremely slow and difficult. Prevention of hip fractures in the elderly therefore remains the primary responsibility of any caregiver.
Fortunately, we now have a new invention known as a hip protector which has been found to be so effective as to reduce the risk of hip fracture by 80%. A hip protector is a slip-on girdle that is worn over the sides of the hip. It is padded on the outside to absorb any shock that you would have otherwise encountered in the event of a hard landing.
It is designed to absorb and deflect the force of impact away from the hip to the surrounding tissues, which can absorb the impact. It is highly recommended that seniors at increased risks of hip fracture wear this protector as a safety precaution.
While hip fractures are commonplace and likely to happen at an elderly stage, they can be maintained and even prevented by a raft of measures ranging from medicinal to lifestyle changes. As mentioned above, a hip protector is quite effective in preventing hip fractures. Many elderly patients may find it cumbersome to wear them but the fall-proof protection that it offers cannot be underestimated. Some of these precautions need to be taken now before you advance in age. It is never too early to start investing in a healthy lifestyle, get in the habit of eating a well-balanced diet and incorporate regular exercises into your daily routine. This might just as well be the only surefire guarantee to enjoyable painless days in your sunset years.
Work with other like minded individuals. Some harmful habits that are picked up from peer groups tend to affect us all through to old-age. If we have to start now we have to start on the right foot with the right people. For the older individuals, a good support system will be invaluable. It will not only help them stay active, they will also be involved in activities hence remain physically healthy. In addition, fall proofing the environment they stay in and screening them for potential risks will significantly reduce their chances of falling. Screening can be done at the hospital and aspects like eyesight, bone structure and strength, mental, and others be assessed in order to come up with an effective assistive strategy for fall prevention. Finally, the importance of educating seniors about the effect of falls, risk factors, and fall prevention cannot be underestimated.