FALLS PREVENTION

Falls Prevention In The Geriatric Population

Falls Prevention In The Geriatric Population

Introduction

Falls are a major health problem among older adults. In the United States one in three people aged 65 or more living in the community fall at least once a year. This proportion increases to one in two for those over 80 years. Worldwide, adults aged over 70 years, particularly females, have a significantly higher fall related mortality than younger people. The severity of fall related complications also increases with age.

The primary sequelae of falls include fall related injuries, such as fractures and head injuries, and post-fall anxiety. These lead to loss of independence through disability and fear of falling. The reduction in mobility and independence are often serious enough to result in admission to hospital or a nursing home or even premature death.8 9 In the United States in 1994 the total cost of fall injuries for older people was around $20.2bn and is projected to reach $32.4bn (in 1994 US dollars) by 2020.

Although the extensive literature on interventions to prevent falls provides many insights, there is no clear message about how best to prevent falls in older adults. To identify effective interventions and their relative effectiveness in preventing such falls, we conducted a meta-analysis of relevant randomised controlled trials. This approach builds on earlier work, where beneficial interventions are identified by using separate estimates of absolute effectiveness in different study strata.11 Our strategy provides additional insight by applying a global multivariate model, allowing for assessment of the relative effectiveness of each intervention component while controlling for the effect of other components in multifactorial interventions across all studies.( Mulrow, 1994)

The categories we identified for intervention programmes to prevent falls were multifactorial falls risk assessment and management, exercise, environmental modifications, and education. A multifactorial falls risk assessment and management programme was defined as a focused post-fall assessment or systematic risk factor screening among individuals at risk tied to intervention recommendations and follow up for risks uncovered. Review of drugs was an important component of nearly all the programmes.( Becker, 2003)

Exercise programmes included both general and specific physical activities. Examples of general physical activity included walking, cycling, aerobic movements, and other endurance exercises. Specific physical activity included training targeted towards balance, gait, and strength.

Environmental modification programmes often included a home visit by a professional, who would check for environmental hazards such as poor lighting or sliding carpets and recommend modifications. Some programmes would also assist with implementation of recommendations.( Jensen, 2003)

Educational interventions targeted individuals, groups, or communities. This could vary from pamphlets and posters at senior centres and nursing homes to more intensive interventions such as one to one counselling about risk factors.

To identify relevant literature, we checked the reference lists from 82 reviews and reference lists obtained from the American Physical Therapy Association, American Geriatrics Society, and experts. The Cochrane Library was searched in 2002. We also searched Medline, Ageline, Embase, CINAHL, and PsycINFO databases from 1992 to 2002 using the search terms accidental falls, falling, or fall ...