Falls and Fractures and how to reduce the risk

My Father, Gerry, who we will see is a bit of a character, is 75 now and had a bad fall a couple of years ago from a step ladder. Gerry is a short but heavy man - he loves his food - so he's a little unbalanced and his ankles are not as strong as they used to be. I received a phone call from my mother describing the details and the subsequent hospitalization overnight and how he was in terrible pain. I asked to talk to Dad and the first words out of his mouth were "Humpty Dumpty had a great fall". God bless him!

Our previous posting referred to one of the biggest causes of losing independence as falls in the home. Let's look at some of the details.

• More than one-third of adults ages 65 years and older fall each year (Hornbrook 1994; Hausdorff 2001).
• In 2003 more than 1.8 million seniors age 65 and older were treated in emergency departments for fall-related injuries and more than 421,000 were hospitalized (CDC 2005).
• Among people ages 75 years and older, those who fall are four to five times more likely to be admitted to a long-term care facility for a year or longer (Donald 1999).
• Among older adults, the majority of fractures are caused by falls (Bell 2000).
• In 2000, direct medical costs totaled $179 million dollars for fatal and $19.3 billion dollars for nonfatal fall injuries (Stevens 2005, in press).
• Women sustain about 80% of all hip fractures (Stevens 2000).

How can seniors reduce their risk of falling?

Through careful scientific studies, researchers have identified a number of modifiable risk factors:

• Lower body weakness (Graafmans 1996)
• Problems with walking and balance (Graafmans 1996; AGS 2001)
• Taking four or more medications or any psychoactive medications (Tinetti 1989; Ray 1990; Lord 1993; Cumming 1998).

Seniors can modify these risk factors by:

• Increasing lower body strength and improving balance through regular physical activity (Judge 1993; Lord 1993; Campbell 1999). Tai Chi is one type of exercise program that has been shown to be very effective (Wolf 1996; Li 2005).
• Asking their doctor or pharmacist to review all their medicines (both prescription and over-the-counter) to reduce side effects and interactions. It may be possible to reduce the number of medications used, particularly tranquilizers, sleeping pills, and anti-anxiety drugs (Ray 1990).

Strong studies have shown that some other important fall risk factors are visual impairments (Dolinis 1997; Ivers 1998; Lord 2001). To reduce these risks, seniors should see a health care provider regularly for chronic conditions and have an eye doctor check their vision at least once a year.

What other things may help reduce fall risk?

Because seniors spend most of their time at home, one-half to two-thirds of all falls occur in or around the home (Nevitt 1989; Wilkins 1999). Most fall injuries are caused by falls on the same level (not from falling down stairs) and from a standing height (for example, by tripping while walking) (Ellis 2001). Therefore, it makes sense to reduce home hazards and make living areas safer.

Common environmental fall hazards include tripping hazards, lack of stair railings or grab bars, slippery surfaces, unstable furniture, and poor lighting (Northridge 1995; Connell 1996; Gill 1999).

To make living areas safer, seniors should:

• Consider eliminating some elevations in the home (in some cases this may mean moving to one level)
• Consider any potential furniture or passageway issues – doors should be 36” wide if possible, hallways should be 42”
• All stairs, if used, should have easily reachable handrails which will hold your weight, possibly on both sides of stairways
• Remove tripping hazards such as throw rugs and clutter in walkways
• Use non-slip mats in the bathtub and on shower floors
• Have grab bars put in next to the toilet and in the tub or shower
• Consider replacing your tub with the high step in with a walk in shower
• Have handrails put into any area where elevations change (especially externally)
• Improve lighting throughout the home.

These preventive actions can be complemented with some assistive technologies such as:

• Personal Emergency Pendants
• Home Fall Monitoring Systems
• Consider automating lighting so that you will always have light when you move around
  

Any good contractor can provide the hardware solutions described above and we are willing to share our expertise at Age@Home. These preventive actions should form one of the critical components in any home renovation you consider. However, contact any supplier of grab bars and they'll be able to recommend an installation source locally – make sure they know you don’t want it to look like an institution. If it’s a fairly significant renovation – consider asking them to hire a trained Occupational Therapist to help in the design.