Medical Edge Newspaper Column

Falls in Older Individuals May Be Preventable

May 15, 2009
Dear Mayo Clinic:
I have been reading about efforts to help prevent falls in older patients. What can you tell me about this topic?

Answer:
People age 65 or older have about a one in three chance of taking a tumble within the next year. Fortunately, most falls don't have serious consequences — but some do.

About 5 percent of independent seniors who fall end up hospitalized with a fracture. Some falls result in nursing home stays or even death. Some seniors limit exercise and activity because they worry about falling. Ironically, that inactivity actually makes them more vulnerable to falling.

With a little effort and some medical problem solving, many falls might be preventable. The Rand Corporation, a nonprofit research group, conducted a large study called Assessing Care of Vulnerable Elders (ACOVE). One focus of the study was falls and how to prevent them. The research wasn't a single study, but an analysis of hundreds of previously published studies. Some of the key findings from ACOVE and updates that have been published in the Journal of the American Geriatrics Society include:

Don't ignore a fall. An older adult who falls once is likely to fall again. Any fall — even when no injury occurs — should trigger a prompt medical assessment of risks contributing to falls. The assessment should cover the senior's "fall history," including circumstances of the fall and reviews of the person's current medications, chronic health conditions, mobility concerns and alcohol intake.

Formulate a plan to reduce the risk of falls. Seniors should work with their health care providers on a plan to reduce the risk of falls. The assessment mentioned earlier provides the basis for a plan that could include recommendations and treatment in the following areas to help with fall prevention:

• Blood pressure: Low blood pressure can cause light-headedness when standing up and contribute to a loss of balance.
• Eye exam: Cataracts and other eye conditions can reduce vision and limit a person's ability to see their surroundings.
• Gait and balance: Some medical conditions, as well as overall fitness levels, affect gait and balance. Many of these conditions can be treated.
• Cognitive assessment: Detection and management of changes in cognitive ability can alert a senior or his or her family members that he or she may not always use the best judgment to avoid situations that increase the risk of falls.
• Medication review: Benzodiazepine medications such as diazepam (Valium) and alprazolam (Xanax) are associated with an increased risk of falls. A provider may suggest tapering off all tranquilizer medications, including sleeping pills.
• Assistive devices: A cane or walker might be appropriate to increase stability and maintain independence. But it takes more than a quick trip to the pharmacy to gain benefit from these tools. Selecting the right device and correct size are critical, as are instructions and training in proper use. Physical or occupational therapists can help their patients select and use these tools properly.

De-clutter the house: Research emphasized the importance of reducing hazards in the home. A dimly lit hallway, electrical cords, loose rugs or clutter on the floor can increase the risk for falling.

Keep moving: Exercise programs that incorporate balance training and muscle strengthening reduce the risk of falls. It's never too late to start. Studies have shown that older adults who started exercising after retirement had balance nearly as good as those who had always been active. Conversely, those who had once been active and then stopped had balance nearly as poor as those who had never been active.

One exercise option is tai chi, a self-paced system of gentle motion where one pose flows into the next. Strong evidence in the medical literature indicates that regular tai chi practice reduces falls. Availability of tai chi classes seems to vary by region — more on the East and West Coasts and fewer in the Midwest.

If you are worried about falls — for yourself or a loved one — talk to a health care provider. A physician may use the ACOVE criteria to conduct a risk assessment and develop a prevention plan.

I also strongly recommend tai chi. Classes are increasingly available. If tai chi is not offered in your community, ask your local health club, community center or senior center to sponsor a class.

— Eric Tangalos, M.D., Primary Care Internal Medicine, Mayo Clinic, Rochester, Minn.