Fear of Falling
You are at work and receive a call from your parent’s neighbor. Your father has fallen and is in emergency. This is a scenario many of us with older parents can imagine. Indeed, the stats on falling are alarming. According to Statistics Canada, 1 in 3 seniors aged 65 or older are likely to have a serious fall and 85% of injury related hospitalizations of seniors are due to falls. As seniors grow older, the risk of falling increases; the seriousness of injuries escalates; and mortality due to falls increases to the extent that a fall and the ensuing medical complications among 90+ year olds can frequently result in death.
The purpose of this article is to explain why falling as we get older is more likely and provide information on how to safety proof a senior’s living environment to prevent falls.
Falling: Summary of Risk Factors
The physical and environmental factors that lead to falls are complex. The purpose here is to demonstrate that falls involving seniors result from a number of different factors and each need to be considered to prevent falls.
Illness – Symptoms from acute illness including: weakness, dizziness and pain combined with the effects of medications increase the risk of falling. Balance Deficits from physical impairments or sensory and cognitive limitations that impede one’s gait “or step” make the timing and foot placement a potential risk factor. Normal cognitive changes delay response time when switching attention and lead to a loss of balance.
Growing old frequently means living with chronic health conditions and disabilities. Arthritis, cardiovascular disease, renal disease, or the effects of a stroke all can impair mobility. Problems with foot pain, ulcers and neuropathy contribute to gait and balance issues. Neurological disorders including Parkinson’s, dementia and Alzheimer’s result in physical limitations.
Changes to vision that decrease visual field, acuity and contrast can make it difficult to detect hazards, particularly in unfamiliar environments. The resulting fall or stumble is not recoverable for many elderly people due muscle weakness.
Lastly, slippery floors, throw rugs and slick weather conditions are all contributing factors that lead to falls.
In the previous section we identified the risk of falling can be attributable to multiple physical and environmental factors and effectively preventing falls requires assessments and expertise from various clinicians including pharmacists, occupational and physical therapists and physicians. Assistive device experts available at pharmacies and home health care stores can also be a very important resource.
Five important steps to preventing falls include:
1) A clinical assessment applying the 2011 AGS/BGS guidelines “Falls prevention in the older person” is an excellent starting point to identify potential physical problems.
2) A pharmacist can perform a medications review to identify potential issues with drowsiness/dizziness and other meds that can affect the severity of a fall such as drugs that decrease bone density or increase the risk of bleeding.
3) There are many mobile assistive devices that are designed to enhance balance. Expertise to confirm the appropriate fit and instruction on proper usage is important. However, research has shown that many seniors avoid using the devices due to inconvenience or stigma. Using them needs to be encouraged by the support groups.
4) In the home, de-cluttering spaces, adding appropriate lighting, and providing additional balance aids is crucial. Start with adding bathroom safety items such as grab bars around the tub and toilet. Next, evaluate the bedroom and other frequently used spaces for potential tripping hazards. Rearrange or remove furniture and ensure there is adequate space for walkers and canes. Add or enhance hand rails, particularly for climbing and descending stairs.
5) Exercise Programs designed specifically to address balance and strength are important in reducing overall risk. Continued physical activity with moderate challenges to balance will help address physical impairments.
Author: Mark Beaton, Seniro Vice President of Marketing, BIOS Medical
- Seniors’ Falls in Canada, Second Report. 2014. Public Health Agency of Canada