Health care providers are the first line of defense against falls

Nearly a third of adults age 65 and older experience an unintentional fall each year in the United States. More than 2 million of them seek treatment in emergency departments, but millions more don't report injuries or receive medical care.

In either case, the toll is enormous. Falls are the leading cause of injury deaths in older adults, and hip fractures and head trauma are major contributors to permanent disability and loss of independence.

Older adults fall for many reasons, including failing eyesight, loss of muscle strength and coordination, and medication side effects or interactions. But Todd M. Emanuel, R.N., injury prevention coordinator for the Mayo Clinic Trauma Center, a Level I Adult Trauma Center and Level I Pediatric Trauma Center in Rochester, Minn., stresses that falls are not an inevitable part of aging. And, he says, health care providers, emergency medical services professionals, community members, family members and neighbors can all play a role in preventing them.

"Most fall risk factors are modifiable," he says, but you have to look at all the pieces. To keep seniors safe usually requires a multidisciplinary approach."

The American Geriatrics Society and British Geriatrics Society have developed guidelines to aid in identifying and planning interventions for at-risk seniors. Their recommendations include:

  • Annual vision and hearing tests
  • Regular exercise programs that emphasize flexibility and balance, such as tai chi
  • Medication reviews of prescription and over-the-counter drugs and herbs
  • A footwear assessment by a physical therapist or nurse
  • Referral to volunteer agencies for help with snow removal and other home and yard chores
  • Recommendations for adaptive aids and training in their proper use
  • Home safety assessment and modifications, including grab bars, improved lighting and elimination of tripping hazards

Improving home safety often presents the most challenges, Emanuel says.

"Elderly people are often afraid to report falls or have home evaluations because they fear being sent to a nursing home," he says. "But the opposite is the case. Fall prevention is focused on keeping people in their chosen environment and maintaining their independence."

Emanuel recommends referring patients to community organizations such as the Rochester/ Olmsted County Falls Prevention Coalition, which provides a range of fall prevention services, including no-cost home safety visits (507-328-6895).

Mayo Clinic is also working to expand its fall prevention program. The standard dismissal packet now includes links to community resources for volunteer help, adaptive equipment and home safety evaluations.

Another possibility, still in the planning stages, involves using a simple evaluation tool to identify at-risk people ahead of time and then referring them to a falls prevention clinic.

The clinic would be staffed with a pharmacist, nurse practitioner, physical therapist and home safety experts who could provide assessments and recommendations to help stop falls before they happen.

But even with such programs in place, fall prevention education remains critical for all older adults. Many seniors, their family members and caregivers aren't aware of the factors that make falls likely or how to reduce them. Health care providers can help fill that knowledge gap.

"So many older people think falling is inevitable as they age, but it's not," Emanuel says. There is no reason for anyone to fall and suffer the life-altering consequences."