What you should know about preventing falls

February 15, 2019 Providence Health Team

It’s important for seniors to identify their risk of falling, as falls dramatically impact their lives.

Several risk factors can lead to falls, but many of them can be addressed.

Older adults who have fallen or worry about their risk should have an honest conversation with their providers and care teams.

“I’ve fallen and I can’t get up” may be just a tagline in an old television commercial to some people, but fall risk in older adults is serious, and a spill can come at great personal cost. There is, of course, the considerable financial cost of a fall. The average cost of a fall-related hospitalization is $33,000 dollars; if there is a resulting hip fracture it can climb to $50,000 or more. But the biggest cost is personal, says Colleen Casey, PhD, ANP-BC, the associate clinical director of the Senior Health Program for Providence Health & Services, Oregon and Southwest Washington.

“The personal cost of falling can range across a variety of areas, but it’s primarily a loss of independence. For many folks in their 60s through 80s, the loss of independence can be worse than dying from a fall,” she says. “If they’ve lived in their own home and fallen and broken a hip and can’t go home again, that can be insufferable in a way that is not acceptable to them. They might have to live somewhere else, they might need to have increased caregiving, they might have problems caused by a fracture, and all of that is part of what we consider the risks associated with a fall.”

Because research shows that even a single fall can predict the increased risk of a future fall, it’s important to start paying attention to what Casey calls a “constellation of risk factors,” including:

Strength and balance deficiencies

Inactivity

High-risk medications, either prescribed or over-the-counter

Safety risks in the home, such as poor lighting or slippery rugs

Excessively low or orthostatic blood pressure (with the latter, there can be a ‘woozy’ feeling when rising from a lying position)

Problems with vision and hearing

Behavioral choices such as alcohol consumption

Age and age-related conditions such as arthritis

Acute illness

Unsafe footwear

The good news is that many of these risk factors can be ameliorated. Some steps to take:

Make sure your home is safe. Potential trouble spots include loose throw rugs, poor lighting on stairs and in hallways, and bathroom hazards. Many indoor and outdoor issues can be addressed with low-cost solutions. Formal home safety evaluations by a professional can be helpful for older adults who are most at-risk.

Be mindful of over-the-counter medications with “PM” in the name. “PM” means it has diphenhydramine (brand names include Benadryl and others) in it, which taken over time can be risky for seniors.

Take another look at blood pressure or high-risk medications. Older adults who have been on a long-term drug regimen may need to work with their health care provider to make sure the whole package still works for them or if they can taper off any of the medications.

Find a good balance and exercise program. Casey recommends tai chi because it has been shown to cut fall risk in half when practiced several days a week over a period of at least 12 weeks.

Take care of ears and eyes. Because hearing and vision affect balance, seniors should have regular checkups.

Clean dirty eyeglasses. This makes it much easier to spot a potential tripping hazard, such as a crack in the sidewalk or a power cord on the ground.

Consider swapping multifocal glasses for single-distance lenses. Active seniors who exercise daily, frequently travel or spend time out and about have a higher fall risk with multifocal lenses and should limit those for indoor use.

Invest in smart footwear. Avoid flip flops and slippers that are open at the back or have slippery soles.

Develop a safety action plan. Seniors living alone should make arrangements for someone to check in with them every day, whether a neighbor stops by or an adult child calls at a set time. The plan can also include a safety alert monitor with a fall sensor for frailer adults.

Download and print this home safety checklist from the American Physical Therapy Association:

Casey encourages older adults to speak up about any falls they have, even if they seem minor. “Most people don’t talk about falls with their health care team and I think there are a variety of reasons for that,” she says. “There is embarrassment or stigma about falling. Some seniors may think, ‘I admitted that I fell and now people are going to worry about me or tell me I need to move out of my home.’ But it would be best if people would have an honest discussion with their primary care provider; maybe a physical therapy referral can set them on the right course. There should at least be an annual conversation and if seniors notice anything happening more regularly, then it should certainly be brought to their provider’s attention. It is the same for high-risk medications. A lot of clinics have pharmacists who can annually review their medications.”

For people living in Providence’s Oregon service region, the Senior Health Program is also a valuable resource for fall prevention. Team members such as pharmacists and occupational and physical therapists give community presentations to seniors and their caregivers, as well as health care providers. In the last three years, these presentations have reached more than 1,000 community members. Every year on Sept. 22, there are also special outreach events timed with the National Council on Aging’s National Fall Prevention Awareness Day.

The program has also launched a Geriatric Mini-Fellowship that provides primary care providers with four weeks of intensive training in the essentials of geriatric care, including fall risk evaluation and management. Casey says they encourage the use of a screening tool from the Centers for Disease Control and Prevention called STEADI (Stopping Elderly Accidents, Deaths and Injuries).

Check your risk for falling: download and fill out this STEADI questionnaire, and discuss it with your health care provider.

In Oregon alone, the Providence primary care clinics have screened more than 42,000 people in the past year. The program has worked to develop a protocol for clinical teams to help identify next steps for patients who screen at risk for falling and is piloting a special care pathway to improve the care of patients 75 years and older who have gone to the emergency room or hospital for a fall, especially those who are frail or have memory issues.

Providence St. Joseph Health offers resources for seniors to address their needs and help them preserve their independence. Providence ElderPlace (PACE) provides a wide range of health care and social services for qualifying seniors in Washington and Oregon. Providence Elder at Home serves at-risk and vulnerable seniors who qualify and are patients of select Providence Medical Group clinics in Oregon.

Looking for a trusted health care provider to help you stay healthy and age well? Find a Providence St. Joseph Health provider near you:

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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

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