Falls Revisited in Community Living - By Les Tainter

Statistics: How the Numbers Add Up

Recent studies suggest that 29% of adults over the age of 65 will fall at least once annually.
10% of these “falling seniors” will fall at least twice annually.
After a fall, 25% of older adults will restrict their activity for at least a day or seek medical attention.
More serious injuries such as fractures, joint dislocations, sprains or strains, and concussions occur in approximately 10% of falls.
Rhabdomyolysis, (a breakdown of skeletal muscle tissue) can develop in people who are unable to get up after a fall and remain “down” for a long period of time.
47% of senior adults who fall must have help from another person to get up.
After the fall occurs, a fear of falling again develops in 21-39% who previously had no such fear. Senior adults who fear falling again may restrict their activity and therefore will have a reduced quality of life.

The “Why” of Falls

Most falls result from a combination of intrinsic risks (such as balance impairment) and extrinsic risks (such as a trip or slip). Deficits in gait and balance are the greatest intrinsic factors. Medications, (including over-the-counter drugs), Alcohol, Visual problems, and impairments of cognition and mood remain among the top causes of falls.

Evaluation

Annual screening is recommended for all seniors in community-based living. This is important because seniors do not volunteer information about a previous fall. Screening questions should include information about the number of falls during the past year, as well as whether or not a fear of falling has limited their daily activity.

The Mayo Clinic has developed a very simple fall risk evaluation. Place the test subject in a chair with a mark 10 feet in front of the chair. On command, the subject will rise, go to the mark, and return to a seated position. If the subject completes the task in less than 10 seconds they are considered “normal” for fall risk. 10-20 seconds places the subject in a “moderate risk” for falls and greater than 20 seconds places them in a “high risk” category for falls.

Exercise should be encouraged in all seniors if they can. Those seniors who participated in fall prevention exercises were found to reduce their risk of falling by 23% as compared to a control group that did not exercise. Other studies show that exercise may reduce the number of falls resulting in fractures by as much as 27%.

Tai chi has been proven to be effective in reducing fall rates by as much as 19% when participants used tai chi 1-3 times per week for at least 13 -48 weeks.

Surprisingly, walking is included in many exercise programs but on its own has not been shown to prevent falls.

Assessment

Assessment of gait, strength, and balance is an important early step in fall evaluation. A thorough medication review is also highly recommended. Medications which cause sedation, confusion, or orthostatic hypotension, (a sudden drop of blood pressure when standing) are leading causes. Eye exams are recommended every 1-2 years for adults over 65 years old. Evaluation of cognition and mood are needed to assess fall risk in seniors. Bone density studies are recommended especially for women over the age of 65. Osteoporosis is a major contributing factor to fall which results in hip or other fractures.

Overall, the senior adults in community-based living are at no more of a risk for falls than those that still live at home. They do have a support structure that, if evaluation, assessment, and preventative exercise are properly used can significantly reduce the risk or falling as well as breaking the cycle of fall-fear falling- fall again. This fear of falling cycle can greatly reduce the quality of life and can also make the risk of falling even greater than before. Proper exercise which focuses on increasing strength, balance, and range of motion can be a major force in reducing falls. It should be the focus of all senior living communities to keep seniors “upright” and enjoying these “Golden Years” of their life with as much smiling, love, and happiness as can be humanly possible.