New advice on preventing falls in seniors
Exercise and medication review recommended
For the first time since 2001, the American Geriatrics Society and the British Geriatrics Society have updated their guidelines for preventing falls among older people. They now recommend that all interventions for preventing falls include an exercise component and that a number of new assessments be used, including feet and footwear, fear of falling and the ability to carry out daily living activities. The guidelines, summarized in the Journal of the American Geriatrics Society, also state that fall screening and prevention should be a part of all healthcare practices for older adults.
Falls are one of the most common health problems experienced by older adults and are a common cause of losing functional independence, according to Dr. Mary Tinetti of Yale University School of Medicine and chair of the panel that issued the new guidelines. Given their frequency and consequences, falls are as serious a health problem for older persons as heart attacks and strokes.
The guidelines now state that doctors and other health professionals should determine whether their older patients are at risk of falling by asking if they have fallen recently or if they are unsteady walking. If so, health providers should look for the presence of known problems such as muscle weakness, poor balance or blood pressure that drops too much on standing. If they have these problems, then older adults should receive interventions that focus on:
- Exercise for balance, gait and strength training, such as Tai Chi or physical therapy;
- Environmental adaptation to reduce fall risk factors in the home and in daily activities;
- Cataract surgery where needed, but they recommend against vision intervention as an individual approach;
- Medication reduction, regardless of the number of medications prescribed, with particular attention to medications that affect the brain such as sleeping medications and antidepressants; and
- Focus on raising low blood pressure and managing heart rate and rhythm abnormalities.
The earlier guidelines did not single out any particular exercise regimen. Exercise is essential for any older person who can manage it, according to Dr. Tinetti, adding that the fear of falling can itself lead older people to cut back on activities they used to enjoy. The less they do, the less they eventually are able to do.
The geriatrics groups also have long recommended that the medication regimens of older patients be reviewed and, if possible, scaled back. Earlier guidelines called for reviewing medications only if a patient takes more than four. Now, researchers say that all older patients ought to have their doctors review their prescriptions for any that might increase the risk of falling. Evidence suggests that medications that affect the brain, including antidepressants, sleep medications and medications for anxiety, increase the risk of falling.
The updated guidelines distinguish between a fall that requires intervention and one that might be an isolated incident. An older person should get a fall risk evaluation when the individual:
- Is worried or frightened by a fall;
- Has had two or more falls in the past year;
- Has had one or more falls with injury; or
- Has repeated difficulty with balance when walking.
In various parts of Ohio, the evidence-based wellness program, A Matter of Balance: Managing Concerns about Falls, focuses on helping older adults reduce their fear of falling. Through eight, two-hour group sessions, seniors master strength and balance exercises and discover how to change their environments to reduce the risk of falls. Call your area agency on aging toll-free at 1-866-243-5678 to find available programs to help older adults prevent falls in the home.
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