Preventable falls a menace for elderly

David Heitz

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Dangerous falls plague the elderly population, and most of them are preventable.

So why do they keep happening? A large portion of this week’s edition of JAMA Internal Medicine is dedicated to the topic.

An original investigation by Dr. Kenneth Lam, University of California at San Francisco, Division of Geriatrics, and colleagues uncovered the fall dangers elderly face. The falls could be preventable if the elderly persons had fall prevention tools.

The researchers examined more than 2,600 adults from the 2015 to 2019 waves of the US National Health and Aging Trends Study. “Participants included community-dwelling older adults who would unequivocally benefit from equipment, defined as those with poor physical performance or substantial difficulty bathing, toileting, transferring, or walking,” the authors explained. “Respondents were representative of the US population 65 years and older.”

The authors found that “42 percent of individuals who expressed or demonstrated diminished capability to bath or toilet independently lacked grab bars or seats to help,” they uncovered. “This percentage represents 5 million individuals in the U.S. with unmet need for equipment.”

Doctor laments needless falls

In an accompanying “Teachable Moment,” Dr. Byron Crowe of the University of Colorado laments all the elderly Americans who repeatedly have had debilitating falls. The elderly should not be having spills repeatedly; the causes should be addressed and prevented when they first start happening.

“Falls are a common source of morbidity and mortality for older adults,” Crowe explains. “In 2018, among adults 65 years and older, one in four reported a fall and one in ten reported an injurious fall. There were an estimated 35.6 million falls leading to more than 950,000 hospitalizations and 32,000 deaths in that year alone.

“Given the substantial health burden of falls for older adults, offering interventions that reduce harm from falls is imperative.”

According to doctor studies, they discuss falls with their patients when they happen about 86 percent of the time. However, they only recommend physical therapy about 58 percent of the time, walking about 46 percent of the time, and home modifications about 69 percent of the time.

How falls can be prevented

“Clinicians can improve the care of patients with a history of falls by assessing future fall risk and intervening accordingly with exercise, PT, or multifactorial interventions,” Crowe said.

Falls can occur because of several reasons. “It is important to note any vestibular symptoms that commonly impair balance,” Crowe recommends. “A medication review can identify polypharmacy and centrally acting drugs, such as benzodiazepines and antidepressants, associated with fall risk. If there are concerns with the patient’s visual acuity, referral for ophthalmic evaluation is advised.”

Crowe said doctors also should assess orthostatic vital signs and screen for mood and cognitive impairment. “A discussion of home hazards and ability to perform basic activities of daily living can reveal opportunities for home evaluation by an occupational therapist. Finally, a review of comorbidities can identify fewer common contributors, such as foot and footwear problems, urinary incontinence, and pain.”

In an accompanying invited commentary, Brian E. McGarry of the University of Rochester and Jason R. Falvey of the University of Maryland discuss elderly persons’ desires to stay in their homes as they age.

Addressing unmet equipment needs

“Given the devastating effects of coronavirus disease 2019 (COVID-19) on the US nursing home population, the desire to avoid residential elder care settings is likely to grow,” McGarry and Falvey explained. “Yet, staying at home requires that individuals are as safe as possible from adverse events, such as falls, and capable of performing necessary activities to maintain a reasonable quality of life.

“Housing conditions often play a definitive role in determining how long older adults can safely remain in the home; interventions that make a home more accessible can substantially extend the quantity and quality of time at home.

“These interventions need not be major renovations, but rather low-cost and low-tech changes, such as installing handrails near steps, increasing interior and exterior lighting, or adding grab bars and raised toilet seats in the bathroom.”

There are tools available for assessing elderly persons’ homes for fall safety. “Assessing the home environment is likely a challenge for clinicians who do not see patients in their homes,” the authors conceded.

“However, there are several strategies to identify potential hazards within the home. The U.S. Centers for Disease Control and Prevention’s Stopping Elderly Accidents, Deaths, and Injuries toolkit includes a ‘Check for Safety’ questionnaire with a standardized framework for discussing the home environment; this may guide clinical conversations about equipment and modification needs.”

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I have been in the news business more than 30 years, spending much of my career at some of the best newspapers in the country. Today, I specialize in Denver local news, health reporting, social justice issues, addiction/recovery/mental health news, and topics surrounding homelessness and human trafficking.

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