Commentary: The dangers of a fall for the elderly
The sad thing is that most falls can be prevented, four observers say.
TEXAS: Baby boomers, who once viewed themselves as the coolest generation in history, are now turning their thoughts away from such things as partying and touring alongside rock bands to how to they can stay healthy as they age.
One of the most important parts of healthy ageing is avoiding a fall, the number one cause of accidental death among people 65 and older.
The issue is growing more pressing each day. More adults than ever – 46 million – are 65 and older, and their numbers are increasing rapidly.
The US Centre for Disease Control and Prevention estimates that one in four older adults will fall each year.
Falls are the leading cause of injury and injury deaths among older adults. And, they are costly.
In the US, falls are responsible for an estimated US$31 billion in its annual national health insurance programme costs. This estimate does not account for non-direct medical or societal costs.
People who fall can lose their physical mobility for life, go into a hospital never to be discharged, require skilled nursing or other caregiver support, or become so fearful about falling again that they dramatically limit their daily activities.
The good news is that most falls are preventable, research has identified many modifiable risk factors for falls, and older adults can empower themselves to reduce their falls risks. This means there are opportunities to intervene in clinical and community settings to promote protective behaviours and improve safety.
A LIFE-CHANGING EVENT
Falls can cause fractures, traumatic brain injuries and other conditions that require an emergency room visit or hospitalisation.
An older adult dies from a fall every 19 minutes, and every 11 seconds an older adult is treated in an emergency room for a fall-related injury.
About one in four falls results in needed medical attention, and falls are responsible for about 95 per cent of all hip fractures.
In addition to the physical and mental trauma associated with the fall itself, falls often result in fear of falling, reduced quality of life, loss of independence and social isolation.
There is no single cause for falling. Falls can result from issues related to biological ageing, such as balance problems, loss of muscle strength, changes in vision, arthritis or diabetes.
Taking a combination of several prescription drugs can also contribute to falls.
Lifestyle behaviours such as physical inactivity, poor nutrition and poor sleep quality can also increase the risk for falling.
Environmental hazards inside the home, such as poor lighting and throw rugs, and outside, such as bad weather, standing water and uneven sidewalks, can create situations where falls are more likely to occur.
IT TAKES A CAREFUL VILLAGE
Because falls can be caused by many things, the solutions must also include a diverse set of systems, organisations and professionals.
Activities that foster collaboration across the ageing services network, public health and healthcare system such as health fairs and fall risk screening events, fall prevention programmes, and awareness-raising events can inform decision-makers and legislators about ways to make communities safer for older adults.
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There are many fall prevention programmes offered in communities to promote healthful behaviours and to reinforce positive mental perspectives about falls being preventable.
People concerned about falling should find out where these programmes are offered and which can be most beneficial. Seniors should ask their doctors about fall-related risk factors and what they can do to reduce risk.
MANAGE CHRONIC CONDITIONS
About 70 per cent of older adults have one or more chronic conditions, many of which can increase the risk for falling.
For example, people with diabetes may have vision problems and problems with sensation in their feet. The medications used to treat these conditions can increase fall risk. Taking five or more medications has been identified with increased frailty and higher risk for falling.
While healthcare access and utilisation are important for chronic disease diagnosis and management, 90 per cent of healthcare happens outside the health care setting.
Therefore, older adults need to manage their diseases better. To do this, however, they often need help.
For starters, they should discuss the side effects of all medications with their doctors and also how best to adhere to prescribed treatment regimens, such as when to take medications, whether to take with food and whether there are possible interactions of one medication with another.
Seniors also can consider enrolling in evidence-based disease self-management programmes to improve their knowledge and confidence to manage their conditions as well as enhance lasting skills for goal setting and action planning, such as being physically active for 30 minutes a day for five days a week.
Altering the physical environment can also reduce hazards of falling.
About 44 per cent of falls occur inside the home. In-home risk factors for falls can include dim lighting, clutter on floors, throw rugs and ottomans, missing railings, uncovered wires and extension cords, children and pets underfoot and unsafe bathrooms.
A unsafe bathroom is one with an inappropriate toilet height, high shower or bathtub walls and no grab rails.
MAINTAIN HEALTHFUL BEHAVIOURS
Daily lifestyle behaviours such as physical activity, nutrition and sleep quality can influence fall risk, and these are never too late to change.
Interventions can be successful for people of all ages. Among the most important is physical activity, namely safely performing lower-body exercises to increase strength, balance and flexibility.
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Additionally, seniors should work with their healthcare team to have medications reviewed and eyes checked regularly. Also, they should ask about their vitamin D levels and possible nutritional supplementation.
Matthew Lee Smith is co-director at the Centre for Population Health and Ageing, and Marcia G Ory is distinguished professor, both at Texas A&M University.
Ellen Schneider is research scientist, and Tiffany Shubert is adjunct assistant professor in Public Health, both at the University of North Carolina at Chapel Hill.
A version of this commentary first appeared on The Conversation. Read it here.