Health Alert 159
A gerontology associate of mine recently opened my eyes to the issue of falls and accelerated aging. Falls are the primary cause of accidental deaths in persons over the age of 65. And, falls are the leading cause of injury-related visits to emergency departments.
The good news is that falls are preventable. Today you will learn simple strategies to reduce injuries related to falling. Understanding the consequences and causes of falls should be reason enough for you to take action now to prevent falls in your future.
* Killer Falls *
Falls account for 70 percent of accidental deaths in persons 65 years of age and older. Falls are markers of poor health and declining function. More than 90 percent of hip fractures happen because of falls. One third of community-dwelling elderly persons and 60 percent of nursing home residents fall each year (1).
Older adults are especially at risk for falls because of impairments in balance. Adequate balance is required in gait and other activities to prevent falls. The body controls postural stability by means of the eyes, inner ear balance, and proprioceptive systems. Unfortunately, older adults often have deficits in all of these systems.
Falls do not discriminate. They affect men and women equally. More significantly, falls compound many of the deficits associated with aging. While impaired vision, illness or reduced strength may lead to a fall, the resulting injuries will most certainly decrease functional abilities. A frightening fact is that 40 percent of nursing home admissions are the direct result of a fall (2).
An easy way to remember the common causes of falls is “I HATE FALLING” (3):
- I – Inflammation of joints (or joint deformity)
- H – Hypotension (orthostatic blood pressure changes)
- A – Auditory and visual abnormalities
- T – Tremor (Parkinson’s disease or other causes of tremor)
- E – Equilibrium (balance) problem
- F – Foot problems
- A – Arrhythmia, heart block or valvular disease
- L – Leg-length discrepancy
- L – Lack of conditioning (generalized weakness)
- I – Illness
- N – Nutrition (poor; weight loss)
- G – Gait disturbance
* Bracing for Falls *
Eliminating hazards that increase the likelihood of falling in the home and getting a better pair of eyeglasses are two obvious steps that people can take to reduce their risk of falls. But this study reminds older adults that maintaining leg strength through regular exercise is the key to better balance — and fewer falls.
Some obvious steps that you can take to reduce your risk of falling are to eliminate household hazards and monitoring your vision and auditory
I have continually advised my patients to exercise. And once again, research has proven that the single most effective thing you can do to prevent a fall related injury is to do exercises that increase strength and balance. Focus these exercises on your quadriceps. These muscles support the knees and the lower legs. By increasing your quadriceps strength you will gain better overall postural balance and reduce your risk of falling.
Try standing on one leg at a time. See how long you can do it. Always repeat with the opposite leg. The more you do it, the longer you will be able to balance on one leg and you will increase strength in your quadriceps.
Another exercise that focuses on the quadriceps and improves strength and balance is the side leg lift. Hold on to a chair or table in front of you. Keep your toes pointing forward and lift one leg about six inches off the ground. Hold that position for one second, then lower your leg and repeat. Be sure to switch legs and do an equal amount of lifts with the opposite leg. Eventually, you will not need to hold onto anything and you will be able to this exercise with your eyes closed.
Remember, inactivity and age naturally diminishes overall strength. By adhering to an exercise routine you will become stronger and live a longer healthier life.
AL Sears, MD
(1) Fuller, George F. Falls In The Elderly. Am Fam Physician 2000; 61:2159-68,2173-4.
(2) “Guideline for the Prevention of Falls in Older Persons,” Journal of the American Geriatrics Society, May 2001.
(3) Sloan JP. Mobility failure. In: Protocols in primary care geriatrics. New York: Springer, 1997:33-8.
Home Safety Checklist
(Rubenstein LZ. Falls. In: Yoshikawa TT, Cobbs EL,
Brummel-Smith K, eds. Ambulatory geriatric care. St. Louis: Mosby, 1993:296-304.)
All living spaces
- Remove throw rugs.
- Secure carpet edges.
- Remove low furniture and objects on the floor.
- Reduce clutter.
- Remove cords and wires on the floor.
- Check lighting for adequate illumination at night (especially in the pathway to the bathroom).
- Secure carpet or treads on stairs.
- Install handrails on staircases.
- Eliminate chairs that are too low to sit in and get out of easily.
- Avoid floor wax (or use nonskid wax).
- Ensure that the telephone can be reached from the floor.
Bathrooms
- Install grab bars in the bathtub or shower and by the toilet.
- Use rubber mats in the bathtub or shower.
- Take up floor mats when the bathtub or shower is not in use.
- Install a raised toilet seat.
Outdoors
- Repair cracked sidewalks.
- Install handrails on stairs and steps.
- Trim shrubbery along the pathway to the home.
- Install adequate lighting by doorways and along walkways leading to doors