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Unintentional injuries caused by falls are a serious health problem for adults ages 65
and older. Each year approximately one-third of community-dwelling older adults (those
ages 65 and older) fall; roughly 10% of falls lead to nonfatal but serious injuries. Whats
more, many older adults experience multiple falls. In the United States, fall-related
healthcare expenses are estimated at $27.3 billion. This article addresses falls among
older adults living in the community or long-term care facilities.
acute illnesses
Because these drugs cant always be avoided, here are suggestions for reducing the risk.
For older adults who need NSAIDs, some experts recommend low-dose ibuprofen.
Older adults receiving benzodiazepines must take particular care during the first 2 weeks
of drug therapy, when the risk of falls and hip fracture is higher.
loratadine) is preferred.
Opioids can have mixed results in older adults and are associated with fractures. When
possible, avoid administering meperidine, propoxyphene, and codeine because these
drugs may significantly increase the fall risk. Start with low dosages and titrate upward
slowly as needed. Know that tolerance to side effects usually develops within a few days;
after that, patients typically return to a fully alert status and baseline cognitive function.
Cognitive impairment
Patients with cognitive impairment and dementia have a poorer post-fall prognosis than
cognitively intact patients. Also, they are at greater risk for sustaining a serious injury,
less likely to make a good functional recovery, and five times more likely to be
institutionalized than patients with dementia who dont fall.
If your patient has dementia, assess for cognitive or perceptual limitations so you can
plan and implement a rehabilitation program that promotes functional safety and helps
the patient to continue or resume activities of daily living (ADLs).
bone mass and conserve or improve bone mineral density; it also might reduce hipfracture risk by decreasing the risk of falls.
Epidemiologic evidence suggests that being physically active can nearly halve the
incidence of hip fracture in older adultsan effect probably mediated through the
positive effects of exercise on bone, muscle strength, balance, and joint flexibility.
Studies have found that women who engaged in a walking program and other leisuretime activities were 55% less likely than sedentary women to suffer a hip fracture. Also,
aerobic, weight-bearing, strength-training, and stretching exercises increased lumbarspine bone mineral density in women receiving calcium and vitamin D supplements.
Although the average older woman isnt likely to exercise to the level needed to build
bone, exercise is crucial to strengthening muscles, improving balance, and preventing
falls. Ideally, a weekly exercise program should incorporate at least three sessions
lasting 30 to 60 minutes each.
Research shows exercise and hormone replacement therapy (HRT) have independent
benefits in early postmenopausal women with adequate calcium intake. In a 12-month
study, 320 women (average age, 56) who were 3 to 11 years postmenopausal were
prospectively randomized into two groupsthose receiving HRT and those not
receiving it. Both groups either participated in a supervised weight-bearing and weightlifting program or continued their current physical activity level. All the women received
calcium citrate 800 mg/day. After 12 months, those whod exercised experienced
significant mean increases in trochanter bone mineral density. Those whod received
HRT showed significantly increased bone marrow density in the total body and at the
lumbar spine, regardless of exercise status. Women whod neither exercised nor
received HRT generally lost bone mineral density at all sites.
When encouraging older adults to increase their activity level, consider their possible
need for pain management. Older adults frequently complain of joint pain. If
acetaminophen or nonsteroidal anti-inflammatory drugs fail to bring relief or if a patient
has more than mild or moderate pain, consider opioids. Keep in mind that older adults
generally achieve pain relief from smaller opioid dosages than younger people.
Relatively inexpensive home modifications can reduce the risk of falls. Studies show
home modifications improve overall functional ability and help patients retain better
function in independent ADLs. The U.S. Department of Veterans Affairs offers grants for
home modifications, mobility aids, and prosthetics to eligible veterans under certain
conditions.
If the patient and family seem overwhelmed by the need to modify the home, help them
identify available resources or find skilled contractors, or suggest they contact the local
affiliate of the National Association of Home Builders (www.nahb.org).
Rosenthal TC, Williams ME, Naughton BJ, eds. Office Care Geriatrics. Philadelphia, PA:
Lippincott Williams & Wilkins; 2006.
Terrell KM, Heard K, Miller DK. Prescribing to older ED patients. Am J Emerg Med.
2006;24(4):468-478.