Falls have a profound impact upon the physiological and psychological health of the elderly, and are associated with increased health care costs and use. Health professionals working with the elderly in community settings should include a comprehensive fall risk assessment as the initial step in planning any intervention strategy.
This assessment would involve those health professionals such as physicians, nurses, community health educators, social workers, and home health workers who spend the majority of their professional role dealing with the elderly. Such an assessment should take into consideration the dynamic interplay among multiple risk factors.
It is the complex interplay among multiple risk factors that contribute to the incidence of falls among the elderly. Such complexity requires careful attention to the individual and the specific risk factors present in daily living patterns. The fall assessment requires a team approach to assessing risk involving social workers, primary health care providers, physical therapists, home health nurses and aids, occupational therapists, geriatric support service workers, volunteers, educators, and others.
Fracture prevention must address different risk factors. Diets that include adequate calcium and Vitamin D and that maintain weight within normal limits are necessary to maintain bone mass. Physical activity that encourages walking and weight-bearing activities is associated with a reduced hip fracture risk. Medications that can reduce alertness, such as long-acting hypnotics and sedating antihistamines, should be avoided. Limiting alcohol intake is important because excess alcohol intake increases the risk of falls. Excess alcohol also has a direct toxic effect on the bone, predisposing to an increased risk of osteoporosis.
Walking aids, stair and bath rails, ramps, and stair lifts should be used for patients at risk for falls. Homes should be evaluated for fall risks such as loose carpeting and irregular flooring surfaces. Prevention and early identification of osteoporosis should be conducted. Biphosphonate medications are beneficial in reducing the risk of nonvertebral fracture in postmenopausal women.
There is some evidence for a reduction in risk of hip fracture with hip protectors in patients at risk for fracture. It is unclear whether exercise results in the reduction of hip fracture risk. Reduction in the rate of hip fractures in postmenopausal women treated with hormone replacement therapy needs to be balanced with potential harm.
Falls and fall-related injuries among the elderly are well-recognized, potentially preventable public health problems. Community-dwelling elderly, those residing outside of nursing homes and institutional settings, comprise a significant percentage of the elderly in the United States (The Institute for Health and Aging, 1996). Approximately 30% to 50% of those over the age of 65 living in the community report having fallen over a one-year period (Graafmans et al., 1996).
Falls have a profound impact upon the physical and psychological health of the elderly. In people over the age of 65, falls are the leading cause of death from injury (Sattin, 1992). Falls result in a fear of falling (Luukinen, Koski, Kivela & Laippala, 1996; Fessel & Nevitt, 1998), account for more restricted activity days ...