Elderly and Falls
Dr. Peter Jacoby
Chair of the Emergency Department
St. Mary's Hospital
Falls are the number one cause of injury-related deaths in the elderly. An estimated 2.7 million persons ages 65 and older in United States are treated for falls at emergency departments, according the to the National Centers for Disease Control and Prevention.
The death rate from falls rose by more than 55 percent between 1993 and 2003, in part because people are living longer and becoming frailer, thus increasing the likelihood of a fatality from a fall. And falls, especially those that cause injury, are the chief reason for admission into a nursing facility. But many falls among the elderly can be prevented.
According to studies, the most common reasons for falling include:
- Gait or balance abnormalities, often resulting from loss of muscle strength and diminished flexibility and mobility.
- Medication use, which can cause dizziness, disorientation or sleepiness.
- Orthostatic hypotension (dizziness upon rising).
- Visual impairment (such as glaucoma, cataracts or macular degeneration).
- Cognitive impairment (such as dementia or Alzheimer’s disease).
To prevent falls, build and maintain a strong body:
- Build muscle strength in thighs and trunk by practicing leg exercises (consulting with a doctor first is advised).
- Improve balance through gentle exercises such as yoga or tai chi.
- Increase flexibility through daily stretches.
- Keep bones strong by consuming enough calcium and vitamin D and by conducting bone-benefiting exercises such as walking, aerobics, dance, tai chi, yoga and resistance training, among others. (Consult with your doctor for details and recommendations.)
- Have annual vision and hearing exams and do not delay getting new hearing aids, eyeglasses or undergoing cataract surgery if these vision enhancements are advised.
- Check to make sure that none of your medications, taken alone or in combination, cause dizziness, sleepiness or other problems; if so, check with your doctor to see if there are any dosage or medication alternatives.
- Keep alcohol consumption in check, especially if you are taking medications that cause drowsiness or have warnings that advise against consuming alcohol.
To prevent falls, keep the environment secure:
- Keep hallways and other walking paths free and clear of any obstacles, including furniture
- Remove loose rugs or secure them with double-sided tape or slip-resistant mats.
- Keep loose objects off the floor and stairs.
- Keep halls and stairways well lighted with overhead light switches on both ends.
- Keep a lamp next to the bed where it can be easily reached at night.
- Make sure indoor and outdoor stairs are sturdy and in good repair.
- Install securely attached runners, carpeting or non-slip rubber treads or non-slip tape on indoor stairs.
- Always hold on to the handrail, install secure rails on both sides, if necessary.
- Install grab bars in the shower or bathtub and next to the toilet.
- Use nonstick rubber mats in bath and shower areas and mats or carpeting on tile floors.
- Put things you use often within easy reach in cabinets and on shelves so you do not have to use a step stool to reach them. Waist height is ideal. If you must get something off a high shelf, use a secure and steady step stool with a bar to hold onto. Do not use a chair.
- Place chairs or benches near entrances for placing packages or resting.
- Know the risks caused by illness or neurological disorders. These can lead to an unbalanced gait, weakness, dizziness or nausea, all of which may lead to falling.
- Be careful on wet surfaces both indoors and outdoors as well as icy surfaces in the winter.
- Additional considerations include installing a walk-in shower instead of a bathtub, creating a no-step entrance into the home (consider a ramp), and widening doors and hallways to accommodate a wheelchair.