Falls Pose a Serious Threat to the Elderly
by Klaus Klein, Dr.Sc. and Dale O. Ritzel, Ph.D.
Falls have come to be recognized as a major threat to the safety, health and independence
of elderly persons. Awareness of various factors associated with falls in elderly
persons and an understanding of some of the methods of preventing falls can help
safety professionals in making appropriate decisions about necessary interventions.
With the growth of the elderly population throughout the world has come a concern
for the well-being of this age group. The elderly are increasing faster than any
other age group and are particularly vulnerable to many social and health problems.
A serious threat to the older population is loss of mobility. In spite of the medical
problems associated with aging, older people still want to live fruitful lives.
Good health, independence and the opportunity to live more productive lives are
essential ingredients affecting the general well-being of the elderly.
The National Safety Council reports that during 1998, "falls" were the second leading
cause of unintentional death. Falls are the second leading cause of injury death
for ages 55-79, but become even more prevalent for individuals over the age of 80.
When all those age 65 and older are combined, falls account for 50 percent of all
injury deaths.
There has been much research to try to determine what causes the elderly to suffer
falls. One thread that seems to run through many of the studies is that mobility
problems and poor health status are strongly related to the frequency of falls.
Research also tends to show that environmental hazards are a contributory factor.
In order to help the elderly reduce the possibility of falling, the health-care
professional must consider the factors related to the person and the environment.
Listed below are the steps that can be taken to prevent falls in institutions, while
fostering residents' autonomy and independence.
- Identify residents who are at high risk of falling: those of advanced age with multiple
pathologies, those on multiple medications, and those with intellectual impairments.
The high-risk profile may differ somewhat from institution to institution.
- Analyze staffing patterns to assure that adequate nursing staff is available to
provide close observation of high-risk residents and to respond promptly to call
lights (Kalchthaler, Bascon & Quintos, 1978; Swartzbeck, 1983). Make certain
call lights are within residents' reach at all times.
- Closely monitor residents during the first few weeks of residence and when they
are moved to new units (Hogue, 1982; Lund & Sheafor, 1985). Resident or volunteer
companion programs and the presence of family members could be helpful during these
periods.
- Closely monitor residents during acute illnesses, such as pneumonia. These are high-risk
times for falling (Tinetti, Williams & Mayewski, 1986; Morris & Isaacs,
1980).
- Closely monitor residents during the post-fall period when the risk for another
fall is thought to be high.
- Sensitize staff to recognize changes in physical vigor and weight that may signal
silent changes in health status, which are a prelude to falls (Brody, Farmer &
White, 1984; Wells, Middleton, Lawrence & Lillard, 1985).
- Monitor the medications taken by elderly residents. Make efforts to reduce the use
of sedatives and tranquilizers in particular (Rane-Szostak & Blandford, 1984;
Swartzbeck, 1983; Wells, Middleton, Lawrence & Lillard, 1985).
- Dress residents in their own clothing; do not permit them to walk about in long
gowns and robes and loose-fitting slippers.
- Ensure a barrier-free environment as far as is possible. Remove carts promptly and
leave hallways uncluttered.
- Quickly eliminate environmental hazards, such as spills, malfunctioning wheelchairs
and the like.
Several strategies aimed at reducing known risk factors appear promising and, in
fact, are being implemented on a limited basis in different parts of the world,
albeit without any rigorous testing to document specific outcomes in the elderly.
They include the following programs and research:
- Multi-disciplinary geriatric assessment of older people at risk for falling, to
identify and ameliorate possible risk factors.
- Careful assessment and monitoring of medication use by the elderly (particularly
drug-alcohol interactions) to help reduce falls and hip fractures.
- Exercise programs to improve gait, balance and muscle mass.
- Public and professional education to identify home hazards and stimulate activities
that will elicit appropriate behaviors.
- Environmental modification of the living quarters of elderly persons consistent
with universal design philosophy (with attention to floor surfaces, lighting, bathrooms,
stairs, traffic patterns, and accessibility) to reduce or eliminate hazards.
- Close monitoring of elderly persons during the first few weeks of institutionalization
and when they are moved to new units.
The heterogeneity of the elderly population requires that we develop interventions
for preventing injuries in relatively healthy people, as well as for reducing injuries
and their consequences in very frail, functionally disabled populations. Although
chronic conditions are the major cause of death and disability among the elderly,
acute conditions and injuries remain an important factor in their illness and death.
For a number of reasons, older people are more likely to suffer from injuries and
infections than other age groups. The factors that place elders at higher risk of
disability from injuries are age-associated physiological decrements and drug side
effects.
Because so many factors can contribute to an injury, health-care professionals should
conduct a thorough assessment to prevent further injuries and to deal with underlying
conditions. Injury control and prevention programs can be effective in reducing
injury susceptibility among elders.
(These comments originally appeared in the March/April 2000 issue of the NSC Research
& Resources Newsletter.)
