Falls and Falls Prevention in Older Adults

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Definition[edit | edit source]

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.[1]

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. [2]

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. [1]

Causes[edit | edit source]

Although falls are common within this population, they can't be considered normal. [3] Falls can be caused by intrinsic and extrinsic factors.[4] Intrinsic factors are those related to the ageing process:

  • Changes in mobility, balance, and reflexes[5]
  • Sarcopenia, functional decline, and reduced muscle strength [6] [5];
  • Cognition issues[5]
  • Vision and hearing loss [7];
  • Urinary incontinence [8];
  • Medical conditions, inclusive of untreated pain, vestibular issues, cardiorespiratory issues[9] [5]
  • Fear of falling and previous falls[10];
  • Gender (older females are more prone to falls than older males)[5] [11];
  • Social isolation [5] [12];
  • Medications [5];
  • Vit D deficiency [13] [5][14]

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.[15]

Most factors, both extrinsic and intrinsic, are modifiable and preventable with evidence-based medical and allied health intervention [16]. 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.[17]

Risk Assessment[edit | edit source]

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 [17]. 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.[18]

For community-dwelling older adults, the risk screening can be done using:[edit | edit source]
For older adults living in residential aged care[edit | edit source]

Interventions[edit | edit source]

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[22]. The OTAGO program has shown to be beneficial to improve of balance in community-based individuals.[23]. Older adults at increased falls risk should be offered an exercise program for falls preventions.[24][25]

As example of falls prevention strategies:

  • Hazards removal, adequate lightning or environment modification [15][25]
  • Well-fit and appropriate footware[17]
  • Medication review [24]
  • Equipment review (ie gait aid, transfer aid - are they suitable? need repair/ replacement?) [17]
  • use of personal alarms
  • Cognitive-related interventions [26][25]
  • Opportunities for engagement such as activities to prevent social isolation [12]
  • Vitamin D supplementation [14]
  • 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.) [17][27]

Related Pages[edit | edit source]

Physical Activity in Ageing and Falls

References=[edit | edit source]

  1. 1.0 1.1 World Health Organisation. Falls [Internet]. [place unknown], World Health Organisation, [updated date - 2021 April 26; cited date - 2023 November 30]. Available from: https://www.who.int/news-room/fact-sheets/detail/falls
  2. Australia Government. Falls [Internet]. Camberra (ACT). Australia Institute of Health and Welfare (AU). [updated date - 2023 July 06; cited date - 2023 November 30]. Available from: https://www.aihw.gov.au/reports/injury/falls
  3. National Center for Infectious DiseasesKeep on Your Feet—Preventing Older Adult Falls [Internet]. Atlanta (GA). Centers for Disease Control and Prevention (US). [reviewed 2023 March 24 cited 2023 November 29]. Available from:https://www.cdc.gov/injury/features/older-adult-falls/index.html
  4. Nugraha S, Sabarinah S, Susilowati IH, Rahardjo TB. Intrinsic and extrinsic risk factor for fall among community dwelling Indonesian elderly. Open Access Macedonian Journal of Medical Sciences. 2022 Mar 9;10(B):619-24.
  5. 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 Appeadu MK, Bordoni B. Falls and fall prevention in the elderly.
  6. Yeung SS, Reijnierse EM, Pham VK, Trappenburg MC, Lim WK, Meskers CG, Maier AB. Sarcopenia and its association with falls and fractures in older adults: a systematic review and meta‐analysis. Journal of cachexia, sarcopenia and muscle. 2019 Jun;10(3):485-500. BibTeXEndNoteRefManRefWorks
  7. Gopinath B, McMahon CM, Burlutsky G, Mitchell P. Hearing and vision impairment and the 5-year incidence of falls in older adults. Age and ageing. 2016 May 1;45(3):409-14.
  8. Moon S, Chung HS, Kim YJ, Kim SJ, Kwon O, Lee YG, Yu JM, Cho ST. The impact of urinary incontinence on falls: A systematic review and meta-analysis. PLoS One. 2021 May 19;16(5):e0251711.
  9. Lee K, Davis MA, Marcotte JE, Pressler SJ, Liang J, Gallagher NA, Titler MG. Falls in community-dwelling older adults with heart failure: A retrospective cohort study. Heart & Lung. 2020 May 1;49(3):238-50.
  10. Asai T, Oshima K, Fukumoto Y, Yonezawa Y, Matsuo A, Misu S. The association between fear of falling and occurrence of falls: a one-year cohort study. BMC geriatrics. 2022 Dec;22(1):1-7.
  11. Johansson J, Nordström A, Nordström P. Greater fall risk in elderly women than in men is associated with increased gait variability during multitasking. Journal of the American Medical Directors Association. 2016 Jun 1;17(6):535-40.
  12. 12.0 12.1 Zeytinoglu M, Wroblewski KE, Vokes TJ, Huisingh-Scheetz M, Hawkley LC, Huang ES. Association of loneliness with falls: A study of older US adults using the national social life, health, and aging project. Gerontology and geriatric medicine. 2021 Jan;7:2333721421989217.
  13. Murad MH, Elamin KB, Abu Elnour NO, Elamin MB, Alkatib AA, Fatourechi MM, Almandoz JP, Mullan RJ, Lane MA, Liu H, Erwin PJ. The effect of vitamin D on falls: a systematic review and meta-analysis. The Journal of Clinical Endocrinology & Metabolism. 2011 Oct 1;96(10):2997-3006.
  14. 14.0 14.1 Thanapluetiwong S, Chewcharat A, Takkavatakarn K, Praditpornsilpa K, Eiam-Ong S, Susantitaphong P. Vitamin D supplement on prevention of fall and fracture: a meta-analysis of randomized controlled trials. Medicine. 2020 Aug 8;99(34).
  15. 15.0 15.1 15.2 15.3 Clemson L, Stark S, Pighills AC, Fairhall NJ, Lamb SE, Ali J, Sherrington C. Environmental interventions for preventing falls in older people living in the community. Cochrane database of systematic reviews. 2023(3).
  16. Bergen G, Stevens MR, Kakara R, Burns ER. Understanding modifiable and unmodifiable older adult fall risk factors to create effective prevention strategies. American journal of lifestyle medicine. 2021 Nov;15(6):580-9.
  17. 17.0 17.1 17.2 17.3 17.4 17.5 17.6 17.7 17.8 17.9 Australian Comission on Safety and Quality in Aged Care. Preventing Falls and Harm from Falls in Older People - Best Practice Guidelines for Australian Residential Aged Care Facilities. Australia. [updated 2009; cited 2023 Nov 29] Available from:https://www.safetyandquality.gov.au/sites/default/files/migrated/30454-RACF-Guidebook1.pdf
  18. Phelan EA, Mahoney JE, Voit JC, Stevens JA. Assessment and management of fall risk in primary care settings. Medical Clinics. 2015 Mar 1;99(2):281-93.
  19. National Ageing Research Institute. FALLS RISK FOR OLDER PEOPLE IN THE COMMUNITY: FROP-COM [Internet]. National Ageing Research Institute. 2009. Melbourne (VIC). Available from:https://www.nari.net.au/frop-com
  20. 20.0 20.1 Barry E, Galvin R, Keogh C, Horgan F, Fahey T. Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis. BMC geriatrics. 2014 Dec;14(1):1-4.
  21. Department of Health. Falls Risk Assessment Tool (FRAT) [Internet] Australia (AU) [published on 1999, updated yearly]. Available from: https://www.health.vic.gov.au/publications/falls-risk-assessment-tool-frat
  22. Sherrington C, Fairhall N, Kwok W, Wallbank G, Tiedemann A, Michaleff ZA, Ng CA, Bauman A. Evidence on physical activity and falls prevention for people aged 65+ years: systematic review to inform the WHO guidelines on physical activity and sedentary behaviour. International journal of behavioral nutrition and physical activity. 2020 Dec;17(1):1-9.
  23. Holek R, Pandey J, Pearce A. The Effectiveness of the Otago Exercise Program on Fall Prevention in Rural-Dwelling Older Adults. Archives of Physical Medicine and Rehabilitation. 2022 Dec 1;103(12):e169.
  24. 24.0 24.1 Montero-Odasso M, Van Der Velde N, Martin FC, Petrovic M, Tan MP, Ryg J, Aguilar-Navarro S, Alexander NB, Becker C, Blain H, Bourke R. World guidelines for falls prevention and management for older adults: a global initiative. Age and ageing. 2022 Sep;51(9):afac205.
  25. 25.0 25.1 25.2 Nascimento MD. An overview of fall risk factors, assessment measures and interventions in older adults.Geriatrics, Gerontology and Aging. 2018;12(4):219-24.
  26. Lipardo DS, Tsang WW. Falls prevention through physical and cognitive training (falls PACT) in older adults with mild cognitive impairment: a randomized controlled trial protocol. BMC geriatrics. 2018 Dec;18:1-2.
  27. Santesso N, Carrasco‐Labra A, Brignardello‐Petersen R. Hip protectors for preventing hip fractures in older people. Cochrane Database of Systematic Reviews. 2014(3). BibTeXEndNoteRefManRefWorks