Tips for fall prevention for elderly patients
Fall is the most common cause of accidental deaths among the elderly and the injury-related visits to emergency room. 5 to 15% of the elderly fall victim suffers from serious injuries like head trauma, soft tissue injuries, fractures and dislocations. And 90% account to hip injuries in the elderly and the leading cause of an extended hospitalization due to the loss of mobility. There are these normal physiological changes that accompany aging process and this can lead to decreased balance and increased risk for falls. Imagine an elderly walking with a walker or cane, most of the elderly lack the upper body strength to effectively support their entire weight on their arms, and walk on the non-weight bearing of affected limb. There are age related changes that may contribute to the risk of falls
among the elderly. This includes decreased range of motion (ROM) and flexibility especially on the lower extremities and the spine. Lower extremities strength can decrease up to 40% from ages 30 to 80 resulting to weakness. Increased postural sway and thoracic kyphosis may also contribute. The three sensory systems which coordinate to provide postural control may change and cause an imbalance. Like if there is a decrease in hair cells in the semicircular canals then it affects the vestibular control, or there is a decrease in the visual acuity, depth perception, cone cells, and accommodation, or if there is an increase in the threshold of excitability for sensory receptors resulting in decreased reaction time of the somatosensory system. The risks of falls in the elderly are multifactorial and also include the environmental, physiological and psychological factors. It can be categorized into the intrinsic and extrinsic factors. Intrinsic factors are those of the person's age, genes, physiological and psychosocial conditions. It may include a person's postural instability, orthostatic hypotension, sensory deficits, foot problems like toenail length, calluses, bunions, and deformities, limited range of motion, cognitive deficits, and depression, acute illness like syncope and dizziness, and muscle weakness, deconditioning and wasting. Under the physiological changes are the neurological, musculoskeletal, cardiovascular, and other systemic changes. Like in neurological changes, there can be slowed reflexes, tremors and difficulty of movement, and loss of balance. Some musculoskeletal changes include decreased muscle mass and strength or even muscle atrophy, decreased mobility and stability, change of gait usually shortened and wider base, increased brittleness of the bones, and deterioration of joint capsule components. For the psychosocial concerns, the elderly usually experiences adjustment to deterioration in physical and mental health and well-being, fear of being a burden to family, loss of skills and competencies, and coping with changes in functions. While the Extrinsic factors arises from an external force that is acting on an individual, such as environmental hazards, for example cluttered hallways and stairways, loose rugs, poor lighting, wet surfaces, and small pets. Another extrinsic risk factor is the use of prescription medication, and use of alcohol and mind-altering drugs.
Fall Prevention
The first thing that is important is to identify the clients who are prone or are at risk for falls, and these usually are
those elderly that already has the history of fall. When appropriate, one can refer to a physical therapist for strengthening, balance and advanced gait training to assist the prevention of falls. Some other steps also reduces the risk of falls such as medication modification, family education on risks and fall prevention, home safety inspection and modification if needed like using non-slip mats in tubs and showers, and the use of assistive device. Maintaining strength and flexibility with a good exercise program will surely help the prevention of falls.
Here are some tips of how to prevent falls in the health care facility
- Identify and report any unsafe conditions in the facility
- Advise residents to avoid alcohol and sedative use
- Identify residents with unsteady gait or difficulty
making transfers; refer to physical therapist for evaluation
- Teach residents to use appropriate assistive devices correctly and at all times
- Review medications frequently
- Assess subtle changes in stamina, social interaction, and ability to communicate, which could suggest a functional decline
- Instruct residents how to change body positions gradually
- Encourage residents to perform strength training and range of motion exercises, wear sturdy shoes with thin, non-slip soles, avoid slippers and running shoes with thick soles
- Notify provider in case of change in hearing, vision,
or physical abilities, and if medications make them feel ill or
weak, and if over-the-counter remedies are used which usually cause drowsiness and unsteadiness
- Provide a well-lighted facility
- Avoid loose mats or cluttered spaces
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