Falls in the Elderly: Deadly But Preventable
One sentinel event often overlooked in aging individuals is a fall. About 1 in 3 individuals who are over the age of 65 will experience a fall in one year. Individuals in this age range who fall and fracture their hip have a 25 to 30 percent chance of dying after one year. Additionally, these individuals often cannot regain their prior level of functional independence. Falls are the most common reason for nursing home placement.
Given the problems associated with falls, the American Geriatrics Society recommends any individual age 65 or older be evaluated if he or she has a fall or complains of difficulty with balance. This evaluation is meant to prevent the next fall or a fall related to balance difficulty. Both of these problems typically have multiple contributing factors. Factors may include problems with vision (cataracts, macular degeneration, diabetic eye changes and glaucoma are the most commonly encountered problems in this population), uncontrolled pain (due to arthritis, particularly in the back, hips or knees), muscle weakness (often related to prolonged periods of inactivity), medications (risk of falls increases with the number of medications an individual takes; lightheadedness, particularly when getting up from laying down or seated, can be an indicator that blood pressure medications are too strong; psychotropic medications like antidepressants and antipsychotic medications all increase the danger of falls). By addressing these issues, the possibility of falls can be reduced.
There are some risk factors for falls, though, that cannot be changed. These include age-specific medical conditions such as dementia, Parkinson's disease, peripheral neuropathy, prior fall and the need to use an assistive device to ambulate.
What should you expect from an evaluation with your doctor? You should be checked for orthostatic hypotension (a significant change in blood pressure when changing position from lying or sitting to standing, often associated with lightheadedness or dizziness occurring after the change in position that tends to go away), asked about pain that limits mobility, checked for muscle weakness (particularly in the lower extremities), checked for significant balance problems, watched by your physician while you walk to see if there are an abnormalities and asked about pain. Your medications should be evaluated to see if there are any that contribute to risk of falls that can be discontinued, and you may also be asked to get your vision checked by an ophthalmologist. An eye chart checks for visual acuity, but it's not as useful when checking for problems with the retina such as macular degeneration or diabetic retinopathy; it's also not useful when checking for problems with peripheral vision.
What can you do yourself to reduce your falls risk? Getting your medications reduced -- particularly removing any psychotropic medications -- is probably the most useful intervention. A physical therapy evaluation can identify specific problems with strength and balance that can be corrected with an individualized regimen of exercises. It's important to do these exercises ever day, and continue the exercises even after formal therapy is completed; otherwise, all that's gained from the therapy could be lost very quickly. Removal of cataracts, particularly in those individuals who have had a fall, is beneficial; it's important to make sure both eyes are done in the shortest period of time possible, and your prescription for corrective lenses is adjusted after the cataracts are removed. There are several exercises that research suggests help reduce the risk of falls. Exercises include tai chi and yoga. Falls risk reduction from tai chi can last for up to two years after a 12-week program is completed.
Given the many interventions an evaluation can identify and you can incorporate into your lifestyle to help reduce the risk, the problem of falling is one that can be reasonably addressed. The alternative of ignoring the issue can have significant implications for your future well-being.
Ronan Mangcucang Factora, MD, is Staff at the Center for Geriatric Medicine, Medicine Institute; Program Director for the Geriatric Medicine Fellowship, Co-Director of the Aging Brain Clinic; and Associate Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. Dr. Factora is a diplomate of American Board of Internal Medicine, with added qualifications in geriatric medicine. His clinical interests include dementia and related disorders, normal pressure hydrocephalus, falls and elder abuse.
Dr. Factora received his medical degree from the Ohio State University, College of Medicine and Public Health, Columbus, Ohio. He completed his internal medicine residency at Montefiore Hospital, University of Pittsburgh Medical Center, Pittsburgh, Penn. and a geriatrics fellowship at Cleveland Clinic, Cleveland.
He is a member of many professional organizations, including the American Geriatrics Society, and is a Fellow of the American College of Physicians.
