Fall prevention
Fall prevention includes any action taken to help reduce the number of accidental falls suffered by susceptible individuals, such as the elderly and people with neurological or orthopedic indications.
Adults aged 65 years and older have a 30% chance of falling each year, making fall-related injuries the leading cause of accident-related death for this demographic.
Impact of falls
Falls and fall-related injuries are among the most common but serious medical problems experienced by older adults. Nearly one-third of older people fall each year, half of which fall more than once per year. Over 3 million Americans over the age of 65 visited hospital emergency departments in 2015 due to fall-related injuries, with over 1.6 million being admitted. Because of decreased bone density due to osteoporosis, mobility, and reflexes, falls often result in hip fractures and other fractures, head injuries, and death in older adults. Accidental injuries are the fifth most common cause of death in older adults. 75% of hip fracture patients do not recover completely and show signs of overall health deterioration.Predicting falls
Insufficient evidence exists that any fall risk screening instrument is adequate for predicting falls. While the strongest predictors of fall risk tend to include a history of falls during the past year, gait, and balance abnormalities, existing models show a strong bias and therefore mostly fail to differentiate between adults that are at low risk and high risk of falling.Physical activity
One of the most important things for fall prevention in elderly populations is to stay physically fit. Physical activity is important for older adults because it plays a major role in limiting the loss of muscle mass and strength, while also stimulating postural control. There are some exercise types that have a higher rate of effectiveness for prevention of falls than others. Postural training is one of the main key exercises to prevent falls. It focuses on improving balance and stability. Pilates is a type of training shown to improve the postural system.It is important to combine muscle strengthening exercises and balance training together to ensure reduced risks of falls. An older adult should be focusing more on strengthening their legs, hip, and core muscles. Strengthening these muscles will provide them with more stability. These exercises may minimize or reduce physical frailty.
After the age of 50, adults experience a decrease in muscle mass by approximately 2% every year. Resistance training can slow down the rate of loss in muscle mass and strength. It has been recommended that older adults participate in resistance training two to three times a week to weaken the effects of sarcopenia. Resistance training also has a positive impact on older adults and can cause a major increase in strength and muscle size. Having a resistance training regimen that includes challenging balance workouts for three or more hours per week results in a lesser chance of falling. Resistance training has been shown to be beneficial beyond fall prevention, as it also helps improve functional mobility and activities of daily living such as walking endurance, gait speed, and stair climbing.
Resistance exercise two or three times a week with ankle weights or elastic bands can rebuild lost muscle mass, improve balance and strength, and reduce falls in adults of all ages.
Specialized facilities and programs like seniors' parks can support to keep the elderly in shape and increase their resistance to falling. These facilities contain specialized equipment and training stations where elderly people can exercise. The parks usually have an extended amount of space and different stages reserved for different body exercises.
Multicomponent exercise with both aerobic and anaerobic components can provide positive outcomes together with specific balance integrations.
Another type of exercise that can be beneficial in decreasing fall risk, specifically in older women, is pilates. Pilates can effectively improve balance which in turn decreases the risk of falls. Pilates also leads to an increase in mobility as well which contributes to a lower fall risk. Due to pilates showing positive effects on balance, leg strength, and mental well-being, this allows older adults to be more physically and mentally strong. These factors can allow for elderly people to be more confident to decrease their fall risk.
Other forms of training, such as aerobic, anaerobic, and proprioceptive exercises can also be used to increase balance to lower the risk of falls in the elderly population.
Adherence
is one of the challenges of a successful fall prevention exercise program. Average adherence in group-based fall prevention exercise programs is around 66%, mostly due to the highly repetitive nature of the programs and the extremely long duration required for noticeable benefits to accrue. Adherence to physical therapy can be even lower. When adherence is below 70%, effectiveness of fall prevention physical exercise programs can drop to less than 10%.Environmental modification
The home environment can present many hazards. Common places for injurious falls include the bathtub and stairs. Changes to the home environment are aimed at reducing hazards and helping support a person in daily activities; they include minimizing clutter, installing grab bars in the bathroom, and installing non-slip decals to slippery surfaces.Environmental modifications, like improving lighting, removing tripping hazards, and repairing uneven surfaces, further contribute to fall prevention. Addressing these hazards within everyday settings helps make interventions practical and accessible, empowering older adults to actively engage in improving their stability and reducing fall risks.
Stairs can be improved by installing handrails on both sides, improving lighting, and adding colour contrast between steps. Improvement in lighting and luminance levels can aid elderly people in assessing and negotiating hazards. Occupational therapists can help clients improve fall prevention behaviours. In addition, they can instruct clients and their family members on factors that contribute to falls, and implement environmental modifications and strategies to decrease the risk of falls. There is currently insufficient scientific evidence to ensure the effectiveness of modification of the home environment to reduce injuries. Evidence suggests that pre-discharge home assessments are associated with a reduced risk of falling.
Safety technology
Important improvements to prevent falls include handrails and grab bars, which should be easy to grip or grasp and should be near any stairs or change in floor level. Floors should always be flat and level, with no exposed corners or edges. Patterned floors can be dangerous if they create misleading or distorted images of the floor surface, and should be avoided.There are special handles and closed handgrips available in bathrooms and lavatories to help users bend down or over. For example, extra support for users when moving include walking sticks, crutches, and support frames, such as a walker. Flexible handles such as hanging straps can also be useful supports.
Medication management
Certain medications can increase fall risk factors for people. The aim of medical management is to identify factors that can contribute to falls and fracture risk such as osteoporosis, polypharmacy, balance and gait problems, loss of vision and a history of falls.The Beers Criteria is a list of medications that are potentially inappropriate for use in the elderly and some of them increase the risk of falls.
Healthcare
In a clinical environment, fall prevention strategies include the use of specific tests for gait and balance assessments, multifactorial interventions, medication review, physical exercises, vision and footwear intervention, physiotherapy referral, environment modification, risk stratification, management of osteoporosis and fracture risk, and cardiovascular interventions.Challenges for falls prevention include such as transportation barriers, gaps in continuity of care, and the need for sustained support for frail individuals. Long-term, sustainable fall-prevention programs benefit from partnerships between healthcare providers, caregivers, and community resources, helping to maintain independence and enhance quality of life for older adults. These efforts not only improve patient outcomes but also reduce the broader strain on healthcare systems, highlighting the societal value of comprehensive, community-based fall-prevention interventions.
Questions around effectiveness of current approaches have been found in multiple settings, including long-term care facilities and hospitals. Physical exercise programs seem to have limited effectiveness. Even multifactorial interventions, which include extensive physical exercise, medication adjustment, and environmental modification only lower fall risk by 31% after 12 months, and by 21% after 24 months.
Occupational and physical therapy
In older adults, physical training and perturbation therapy is directed to improving balance recovery responses and preventing falls. Gait-related changes in the elderly provide a greater chance of stability during walking due to slower speed and greater base of support, but they also increase the chance of slipping or tripping and falling. Appropriate joint moment generation is required to create sufficient push-off for balance recovery. Age-related changes in muscles, tendons, and neural structures may contribute to slower reactive responses. Interventions involving resistance training along with perturbation training may prove to be beneficial in improving muscle strength and balance recovery.Stroke exercises help patients regain mobility and strength in their bodies, and must be done regularly to regain muscle tone that helps prevent falls.