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Older Adults: Are You At Risk?

Can you guess what will happen to one out of every four Americans age 65 and older this year?  Every 11 seconds, this same situation will cause an emergency room visit for an older adult, and every 19 minutes an older adult will die as a result of this situation.

Sounds pretty scary, doesn’t it?  The good news is that although everyone is at risk, steps can be taken to reduce the chances of this situation occurring.  What is this frequent and tragic situation?  Falls.

Geisinger Holy Spirit reports that during each of the months of November and December 2018 and January 2019; falls were the cause of over 50% of the hospital’s trauma cases.  While many older adults experience falls which do not require hospitalization, soft tissue injuries can temporarily impact an individual’s daily functioning and independence. Severe injuries which result from falls, such as fractures (especially hip fractures) and head trauma, may lead to long-term disability and an earlier death, even in individuals who are healthy prior to the fall. Once a fall occurs, an older adult has a significant risk of another fall happening within one year.

Even without an actual fall, the fear of falling can have a significant impact on the quality of life of older adults. This fear may cause older adults to limit their activities.  The adage “move it or lose it” describes the fact that limited physical activity results in physical decline including decreased muscle strength, balance, and coordination. These changes further increase the chances that a fall will occur.  Limiting physical activity also affects opportunities for social engagement, resulting in a risk of isolation. Isolation affects mental and emotional well-being through the development of feelings of helplessness, anxiety, and depression.  Social isolation has also been linked to the exacerbation of physical health issues and increased mortality rates.

Recognizing risk factors for falls is the first step toward reducing one’s chances of a fall.  Certain risk factors cannot be eliminated, such as age, vision changes, and the presence of certain health conditions such as Parkinson’s disease, arthritis, stroke and dementia.  Regular monitoring of one’s health and the initiation of interventions to reduce the symptoms of a particular condition (examples: physical therapy for muscle weakness/joint stiffness or new eyeglasses for vision changes) can mitigate some of the risk.

Other elements can be controlled.  Certain medications such as those used to treat depression, insomnia, anxiety, seizures, and certain heart conditions increase the likelihood of falls and should be reviewed with one’s physician. Be aware of environmental hazards which contribute to falls including inadequate lighting, uneven surfaces (indoors this includes throw rugs), transitions between different types of flooring, and heavily padded carpeting), the presence of clutter, and furniture (i.e. beds and chairs) that are too high or too low for the older adult.  Choice of footwear is probably the easiest adjustment one can make to try to prevent falls. Sturdy footwear with non-skid soles is ideal, but avoid choosing footwear which may feel heavy for someone who has difficulty lifting his/her feet when walking. 

It is interesting to note that many falls may be attributed to slipping or tripping. A study done in British Columbia, however, disputed this belief.  Instead of relying on personal or witness reports of falls, the data for the study was obtained from video recordings of falls which were analyzed by mobility experts.  (The recordings were obtained from two nursing homes which had cameras installed in public areas with permission from residents and staff).  The analysis indicated that a greater number of falls were caused by the improper transfer or shifting of one’s body weight, which affected the body’s center of gravity.  Reaction time to the sensation of falling was intact, but muscle strength did not appear strong enough to counteract the imbalance and prevent a fall.  Appropriate techniques for changing position, walking, and use of assistive devices, as well as improved muscle strength, can be addressed by physical and occupational therapy and maintenance exercise programs.

Tools are available which can assist individuals in determining an older adult’s fall risk.  Learn more next week.

Karen Kaslow, RN, BSN