Jan. 13, 2011 -- Updated guidelines from the American Geriatrics Society and the British Geriatrics Society recommend interventions such as the slow-motion Chinese martial art tai chi along with medication reviews to help prevent falls among the elderly.
The guidelines, which appear in the Journal of the American Geriatrics Society, were last updated in 2001.
Falls among the elderly are linked to an increased risk for hip and other fractures and head injuries, all of which can lead to reduced independence, early admission to long-term care facilities, and even death.
“Given the frequency of falls and the injuries that occur as a result, falling is as big of a problem as heart attack and stroke, and we need to start taking it as seriously because falls are preventable,” says guideline author Mary Tinetti, MD, a geriatrician at Yale University School of Medicine in New Haven, Conn. “The most effective way to prevent falls is to reduce medication, make the environment as safe as possible, and improve balance and gait through exercises including tai chi or physical therapy.”
Tinetti and other panel members reviewed studies looking at fall prevention interventions published between May 2001 and April 2008 to develop the updated guidelines.
Fall Prevention 101
Tai chi and/or physical therapy can help seniors improve their balance, gait, and strength and help stave off falls, the guidelines state.
Medication checkups are also useful for older people who are at risk for falls, Tinetti says. Medications that may increase falling risk include certain antidepressants and sleeping pills.
“We should review all the medications and really decide ‘do they need this medication at this dose’ and determine if the medicine is more likely to cause overall harm vs. overall benefit,” she says. “If a medication puts a person at risk of falling, is it really worth it?”
If a medication can’t be stopped altogether, reducing the dose may also an option, she says. No one should ever stop taking or reduce a dose of any medication without first discussing these risks with their doctor.
Some falls may be caused by poor vision. “Cataract extraction has a lot of benefits for fall prevention,” she says.
Fall Prevention Is Everyone’s Issue
The onus is on everyone involved with the care of the aging population to implement these guidelines, Tinetti says.
“Nurses, physical therapists, specialists, and anybody who is caring for older people should be aware of these new guidelines and follow the components that are relevant to their area of expertise,” she says.
“Older people also need to take more responsibility when they see their care providers,” she says. For example, say ‘I want my blood pressure taken when I stand to see if it drops, and I want you to look at all my medications to see if any are going to increase my risk for falling or make me unsteady,” she says.
Make Fall Prevention a Focus
Ronald P. Grelsamer, MD, an associate professor of orthopedics at Mount Sinai Medical Center in New York City, says fall prevention strategies should be implemented in and outside of the home.
Throw rugs, wires, telephone cables can all increase fall risk in the home, he says. "The bathroom is a dangerous place [and] mats and handles are important," Grelsamer says.
“When walking outside and there is a chance it might be slippery, move your feet apart a little bit because this makes you more stable right away,” he says. “If you are carrying something, carry it in the dominant hand, so if you fall your non-dominant hand will break your fall.”
“The main risk is that they are going to break their hip, but other fractures such as wrist fractures also occur, and emergency surgery is never minor in this population,” he says.
As for the updated guidelines, “I think it is a very good idea to make sure the eyes are as good as they can be and that an older person is not on more medication than they need,” Grelsamer says.