Preventing falls in older adults: Multiple strategies are better

Despite considerable research and clinical effort, falls among people 65 and older are on the rise. An older adult is treated in the emergency room for a fall every 11 seconds, with injuries ranging from simple cuts and bruises to broken bones. Hip fractures are the most serious injury from falls, and more than half of older adults hospitalized for hip fractures after a fall never regain their previous levels of mobility or quality of life. Further, falls are a leading cause of death among older adults. According to the Centers for Disease Control and Prevention, an older adult dies from a fall every 19 minutes. Despite these sobering statistics, falls are not an inescapable part of aging; on the contrary, most falls are largely preventable.

Falls are particularly hard to study — and prevent — because no two falls are the same

Over the years I have interviewed hundreds of older adults who had recently suffered a fall, and one thing is clear: each fall occurs from the unique interaction of the person’s balance, the task they were performing just prior to the fall, and the ever-changing environment in which they were moving. All these things make it difficult to pinpoint the exact cause of a particular fall, and nearly impossible to uncover commonalities across all falls suffered by older adults.

The complexity of falls may be the key to their prevention

It is now quite clear that fall-prevention strategies that target just one factor with a well-known link to fall risk, such as muscle weakness, do not effectively reduce falls in older adults. Instead, researchers now believe that in order to keep older adults safe and free from falls over the years, interventions must continuously target multiple individual and environmental factors.

This current viewpoint is perhaps best highlighted by the ongoing STRIDE clinical trial. This pragmatic trial has enrolled 86 primary care practice sites across the country and over 5,400 older adults who are at risk for falls. The aim of this study is to compare the effectiveness of the current standard of care (which is primarily education about fall prevention) with individualized interventions developed by nurse “falls care managers” working in collaboration with primary care physicians. The falls care manager first assesses the older adult for eight key modifiable risk factors for falls and fall-related injuries: strength and balance, medications, vitamin D deficiency, home safety, orthostatic hypotension, visual impairment, foot problems and footwear, and osteoporosis. They use this information, together with personal preferences from each participant, to devise and implement an individually-tailored intervention that combines strategies for the older adult, recommendations for their doctor, and even referrals to health providers and local community-based organizations to support certain aspects of the intervention.

The STRIDE trial is closed to enrollment; however, data collection and analyses of its effectiveness are still underway. In the meantime, here are five specific actions you can take to minimize risk factors for falling.

• Make exercise part of your daily routine. According to the Harvard Medical School Special Health Report Better Balance, tight, inflexible, or weak muscles together with poor posture and endurance impinge on balance and can lead to falls. Regular, clinician-approved exercise can help counteract each of these factors. A recent analysis in the Cochrane Database of Systematic Reviews concluded that regular exercise may reduce the rate of falls by 23%, and the number of people who fall by 15%.
• Stay mentally active. Researchers have recently identified cognition as a key player in balance and fall risk. This is because we must pay attention to the world around us, avoid distraction, “remember” where our body is in space, and make the right decisions to modify our movements when our environment changes unexpectedly. It is for these reasons that staying mentally active, and participating in mind-body exercises such as tai chi, yoga, or dance, have been shown to be particularly effective fall-prevention strategies for older adults.
• Review your medications. Discuss all of your medications with your doctor and use them strictly as prescribed. Be aware that some medications have side effects (drowsiness, dizziness, muscle weakness, etc.) that may alter your balance and lead to a fall.
• Have your vision and hearing checked regularly. We depend on our vision and hearing to maintain our balance as we move through each day. Wearing glasses and hearing aids when prescribed can reduce the likelihood of balance issues and falls.
• Conduct an annual home inventory. Reorganizing the bedroom, kitchen, living room, and other common areas according to your needs is also important to reduce falls and/or prevent them from recurring over time. For example, keep medicines, clothing, food, dishes, and other necessities for day-to-day living within easy reach. Avoid scatter rugs and remove low-rise furniture, such as coffee tables and bookcases, that may clutter direct access to doors, hallways, and windows. Light the way day and night with lamps by the bed and nightlights in each room, and install light switches by all doors. Handrails on both sides of the stairs and grab bars for the shower and toilet are essential.

It is also important to remember that falls have a significant impact on your quality of life, whether they cause injury or not. Just the fear of falling can cause loss of confidence and depression, which can lead to isolation and anxiety as older adults withdraw from outside activities or social engagements. Implementing multiple preventive measures early and evaluating them often can facilitate your mobility, reduce your chances of losing balance, and help maintain your quality of life for years to come.