Introduction

Falls are common among older people. It is a major cause of injury and trauma in the elderly. Falls could lead to significant morbidity and mortality in elderly, as well as affecting the quality of life of the older persons. The risks of falls are related to the complex interaction among intrinsic factors, extrinsic factors and situational factors and the majority are preventable. Therefore, primary care interventions are important and effective to reduce fall risk and prevent falls among older people.

Prevention

A multi-factorial approach that combines medical, environmental, rehabilitative intervention is often the best strategy to prevent falls in the elderly. Making minor changes to multiple risk-factors and tailor intervention to individual patient are more effective in preventing fall.

Effective fall prevention strategies should be comprehensive. They should include:

• Primary prevention – healthy habits, exercises, education, nutrition

• Secondary prevention – early detection of risks of fall and modify risk-factors

• Tertiary – to treat and rehabilitate underlying cause and consequences

Tips to prevent fall

Interventions attempt to improve functional capacity can prevent or decrease the number of falls and minimize the fall-related injury.

Tips or strategies to prevent fall in the elderly include:

• All elderly especially those with history of fall should be assessed to identify risk of falls and to modify them to reduce risk of future falls

• Multi-factorial interventions includes:

  • Exercise program – gait, balance training

  • Assistive device

  • Environmental hazard modifications

  • Detect, treat the underlying disorder and medication modification

  • Educational program

Exercise program in fall prevention

Muscle weakness and instability underlie most of the falls and certain types of exercise can increase strength and reduce instability and subsequent fall.

The exercise program should be supervised by a trained physiotherapist. Types of exercise which can increase strength and reduce instability include:

• Strength and balance training

• Active or passive exercises

• Increase range of movement exercise

• Increase strength of muscles e.g. using resistance or weights

Assistive device

The use of assistive devices is important to assist in daily activities, to promote mobility and independence and to prevent complications of immobility.

It should be supervised by a trained occupational therapist. The assistive devices include:

Walking aids – to provide an appropriate aid and patient should be taught how to use it, for example:

• Sticks – single-ended, double-ended (hemi-bipod), three-ended (tripod) or four-ended (quadripod to provide additional stability).

• Frame – a structured light weight alloy metal, self-stabilizing with various heights, dept and widths.

• Walkers and rollators – with additional features eg. bigger wheels for uneven ground, a seat or attached basket for shopping or other household tasks, larger than standard frame are useful for outdoor walking.

Environment assessment and modification

Assessing an elderly person’s home for fall hazards and modify them is important to prevent further fall. It should be done with the help of occupational therapist.

Environmental hazard modifications include:

• Improving access by fitting ramps and rails

• Removing steps and elevations

• Providing grab rails in bathroom, toilet and dressing area

• Providing good lighting- passage way especially to toilet

• Bedside commode for those with incontinence or mobility issues

• Suitable flooring and removing carpets

• Reducing clutter

• Rearrange frequently used items for easy accessibility

• Suggest suitable assistive reach out devices

• Safety features to stairs eg. railings, adequate measurements of height and width

• Suggest good quality footwear

Detect, treat the underlying disorder and medication modification

If falls are caused by intrinsic factors, interventions focus on decreasing disease-related impairment should be carried out. The interventions include:

• Treat the underlying medical disorders which have contributed to the intrinsic risk of fall

• Treat infection, dehydration and delirium actively

• Detect and treat osteoporosis to prevent fall-related fracture

• Discontinue drugs that may increase the risk of falls or adjustment of their dosage is recommended

Educational program

The elderly people and caregivers should be educated to minimize the risk of fall by:

• Providing close supervision by caregivers

• Changing of accommodation if indicated

• Patients should be taught how to get up from fall i.e. turning from the supine position to the prone position, getting on all fours limbs, crawling to a strong support surface and pulling-up.

• Having frequent contact with family or friends, a phone that can be reached from the floor or a remote alarm system can decrease the likelihood of lying on the floor for a long time after a fall.

Conclusion

Fall is an important cause of trauma and injury in the elderly and it can lead to serious morbidity and mortality. It is most often multi-factorial but preventable. Therefore, the preventive strategies should include primary, secondary and tertiary prevention. Small, multiple remedial steps are more useful and effective than single intervention to prevent fall and injury and its consequence.