Falls and Falls Prevention in Older Adults

Original Editor - Roberta Villar Baffa Capobiango Top Contributors - Roberta Villar Baffa Capobiango, Kim Jackson and Carina Therese Magtibay

Definition

According to the World health Organisation (WHO), a fall is defined as an event that results in a person coming to rest inadvertently on the ground or floor or other lower level.

Falls are a major health concern and the leading cause of non-intentional injury in older adults (65+). In Australia, falls are leading cause of injury hospitalisation and death, representing 43% of injury hospitalisations and 42% of injury deaths, it's estimated that 10% of falls in older adults will cause a major injury, such as a hip fracture or subdural haematoma.

The financial impact of falls are also significative, for people aged 65 years or older, the average health system cost per fall injury in the Republic of Finland and Australia are US$ 3611 and US$ 1049 respectively.

Causes

Although falls are common within this population, they can't be considered normal. Falls can be caused by intrinsic and extrinsic factors. Intrinsic factors are those related to the ageing process:

• Changes in mobility, balance, and reflexes
• Sarcopenia, functional decline, and reduced muscle strength ;
• Cognition issues
• Vision and hearing loss ;
• Urinary incontinence ;
• Medical conditions, inclusive of untreated pain, vestibular issues, cardiorespiratory issues
• Fear of falling and previous falls;
• Gender (older females are more prone to falls than older males) ;
• Social isolation ;
• Medications ;
• Vit D deficiency

Extrinsic factors are environmental, inclusive of a cluttered environment, low lighting, unsafe footwear, uneven surfaces, steps, slippery surfaces, and home hazards such as rugs and mats.

Most factors, both extrinsic and intrinsic, are modifiable and preventable with evidence-based medical and allied health intervention . Best practice on management of falls and injury prevention include a comprehensive risk and functional assessment of the individual and the implementation of standard and individualised falls prevention strategies.

Risk Assessment

Falls risk screening is a process of estimating an individual’s risk of falling and classifying people as being at either low or increased risk . Depending on where the individual lives, either in the community or in an residential aged care facility, their age, co-morbities, previous falls history, among other factors as seen above, the tools used to screen falls risk will likely differ, as individuals with different characteristics and backgrounds, may have different factors impacting on their falls risk.

For community-dwelling older adults, the risk screening can be done using:

• Falls Risk for Older People in the Community (FROP-Com)
• Timed Up and Go Test (TUG)
• Sit-to-Stand Tests, such as Five times sit-to-stand and 30 seconds sit-to-stand test
• Environmental and equipment assessment: look for hazards, lighting, barriers for mobility, are the available equipment suitable?

For older adults living in residential aged care

• FRAT
• Timed Up and Go Test
• Sit-to-Stand tests, such as Five times sit to stand and 30 Seconds Sit to Stand Test
• Environmental and equipment assessment also applies

Interventions

Falls prevention strategies can be standard and individualised, depending on an individual's needs.

An effective exercise program, inclusive of strength and balance training are proved to reduce falls risk as per WHO guidelines in 2020. The OTAGO program has shown to be beneficial to improve of balance in community-based individuals.. Older adults at increased falls risk should be offered an exercise program for falls preventions.

As example of falls prevention strategies:

• Hazards removal, adequate lightning or environment modification
• Well-fit and appropriate footware
• Medication review
• Equipment review (ie gait aid, transfer aid - are they suitable? need repair/ replacement?)
• use of personal alarms
• Cognitive-related interventions
• Opportunities for engagement such as activities to prevent social isolation
• Vitamin D supplementation
• In residential aged care facilities, consider frequent sightings, staff education, toilet schedule (please note toilet schedule may aggravate incontinence issue - assess risk and benefits), diversional therapy, use of alarms and sensors, and hip protectors (please note that before recommending hip protectors, clinicians should determine whether they are suitable for a particular individual, which is also part of your risk assessment.)

Related Pages

Physical Activity in Ageing and Falls