“I’ve fallen and I can’t get up.” This ad for a medical alert system is a bit of a parody. But it is no joke to an older adult who has taken a bad fall and knows firsthand the feelings of helplessness, pain and shame of not being able to get up from the floor.
I recently taught medical students about falls and fall prevention in the older adult. At the University of Texas Medical Branch Rehabilitation Services we observed skilled physical therapists, occupational therapists, and patients working on fall prevention and rehabilitation.
What do we all need to know about falls?
Falls are the leading cause of death due to injury in the older adult. Nearly 60 percent of all falls result in physical injuries and 20 to 50 percent of these require medical attention including emergency department care or hospitalization. The most important risk factor for falling is a history of falls. Adults age 75 and older who fall are four to five times more likely than their 65- to 74-year-old age cohort to be admitted to a long term care facility for a year or longer following a fall.
As a physician and educator, I emphasize that responding to the first fall in an older person is critical. Immediate identification of risk factors for falls and referral for physical therapy, an exercise program or a specialty consultation as needed is the way to avoid future falls and injury.
If you have had a recent fall and are an older adult, do not brush it aside as a mere accident, “That danged dog!” It may be an early marker of slowly evolving disability and frailty. Tell your doctor even if it didn’t result in a serious injury. Medical and nursing staff are now trained to routinely ask older adults about recent falls.
Major risk factors for falls include a history of falls, a wide spectrum of medical conditions and medications, impaired mobility and gait, sedentary behavior, psychological status, nutritional deficiencies, substance use, impaired cognition, visual and hearing impairments and foot problems.
Physical therapists provide assessments and treatments for balance, gait stability, posture, strength, sensation, blood pressure, joint mobility and pain that may contribute to falls.
Other factors that increase the risk of falls are environmental and home hazards such as uneven surfaces, poor lighting, unstable or inappropriately placed furnishings, inappropriate assistive devices, ill-fitting clothing and footwear.
Occupational therapists and other professionals caring for older adults can make home assessments of environmental and structural risks of falling.
Some steps in fall prevention are increasing exercise such as tai chi or yoga to strengthen core and leg muscles. Reduce medications when possible under your physician’s guidance. Vitamin D and calcium may be helpful. A community resource is UTMB’s Osher Lifelong Learning Institute which offers not only tuition sponsored tai chi and yoga but also free exercise and fitness programs including a free semesterlong class on maintaining balance and fall prevention.
If you want to prevent a fall, exercise regularly. If you have fallen, consult with a health care professional for fall risk assessment and preventive measures. It may save your bones, your brain or even your life.