Falls And Fractures In Older Adults: Causes And Prevention
A simple accident like tripping on a rug or slipping on a wet floor can change your life. If you fall, you could break a bone, which thousands of older adults experience each year. For older people, a broken bone can also be the start of more serious health problems and can lead to long-term disability.
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If you or an older adult in your life has fallen, youre not alone. More than one in four people age 65 years or older fall each year. The risk of falling and fall-related problems rises with age. However, many falls can be prevented. For example, exercising, managing your medications, having your vision checked, and making your home safer are all steps you can take to prevent a fall.
Many older adults fear falling, even if they havent fallen before. This fear may lead them to avoid activities such as walking, shopping, or taking part in social activities. But staying active is important to keeping your body healthy and actually helps to prevent falls. So dont let a fear of falling keep you from being active! Learn about what causes falls and how to lower your risk of falling so you can feel more comfortable with staying active.
Fall Prevention Information For Older Adults And Caregivers
In Massachusetts, for people age 65 years and older fallsare the leading cause of injury-related hospitalizations and Emergency Department visits as well as the leading cause of injury-related deaths. However, falls should never be considered a normal part of the aging process, because most falls are preventable.
There is a lot of information available on how older adults can reduce fall risks, avoid fall-related injuries and follow a healthy aging approach to life. This includes learning more about evidence-based falls prevention programs offered in most communities, removing hazards in the home environment, reviewing medications that may have negative side effects, etc. There is also information available on what to do if a fall happens to reduce further injury.
Check Windows And Doors
For the most part, seniors should be able to open all windows and doors in their home in case they need to escape from a fire. One exception is in high-rise buildings where safety precautions dont allow some windows to open. Another exception is if the senior is prone to wandering off. In general, any security bars in your home should have emergency release devices.
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Strength And Balance Programs
Exercise, particularly exercise that targets strength, gait, and balance, has been found to reduce fall risk, falls, the rate of falls, and death, although the effect differs by duration, intensity, type, time for followup, and other factors . A systematic review for the US Preventive Services Task Force included 18 trials that involved exercise or physical therapy and found a 13% reduction in the risk of falls in a pooled analysis . A review of 59 systematic reviews found exercise consistently effective for community residents, but not for those in care facilities . Exercise was found effective as a single intervention and as part of a multifactorial strategy. Although the results differed in effect size, outcome measure of interest, and components of the exercise intervention , the results overall were robust. The AGS/BGS Guideline recommends an exercise program that targets strength, gait, and balance with the highest grade A recommendation and that exercise be included as a component of multifactorial interventions .
There are a variety of community-based fall prevention programs that providers can refer their patients to that have been found effective in randomized controlled trials. Stevens and Burns produced a compendium of effective programs that include 15 single and 12 multifactorial exercise interventions . Two interventions, delivered in community settings, have also been found to be cost effective , Stepping On and Tai Chi .
Take Care In Wintry Conditions And Other Inclement Weather Situations
Virtually every area of the country deals with bad weather at some time. Seniors in areas that get rain, fog, snow, ice and darkness for longer periods are at heightened risk for falls. To that end, take these approaches:
Wear footwear that has an irregular texture on the soles for the best grip possible. You can also deploy add-ons such as Yaktrax, which fit over your footwear and boost your traction.
Check last years footwear at least a couple of months before wintry weather is supposed to arrive to ensure it can handle another season.
Clean your boots and shoes after you are safely inside. Its easy for snow or ice to freeze on shoes even if you are inside.
Give yourself plenty of time to get places so you dont have to rush.
Stay home if there isnt an urgent need to go out.
Use a grip wherever possible. For example, handrails help you descend steps, and holding onto a door handle gets you out of a car more safely. Similarly, gloves should help you better grip canes, walkers and railings.
Keep your hands free of objects so youre as stable as possible.
Look over your walking options for the safest paths.
Check that your walkers or canes are in good shape from top to bottom. The handle should still offer a good grip, and the tip at the bottom could have a retractable ice pick.
Use an ice carpet to prevent against skids in both good and bad weather. In snow and ice, this carpet should help you maintain good balance when you walk.
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Take Care Of Your Feet And Use Proper Footwear
Proper foot care and proper footwear have been touched on in a few places above but deserve a separate section as well. The basics of what you can do are:
See your doctor as soon as possible if you experience foot pain.
Use shoes that have soles of less than half an inch and that dont have overly padded insoles. Otherwise, you risk shoes that are too high up and that affect your balance. Think wide and low-profile.
Do foot exercises every day such as turning your ankles in a circular motion and moving your toes up and down. They promote good blood circulation.
Replace shoes once tread wear manifests itself.
Use Velcro straps and hook and loop closures when possible. If you strongly prefer laces, keep them snugly tied for the best fit and to avoid a tripping risk.
Stay away from open-backed shoes and heels as they can lead to instability.
Keep your nails trimmed, and treat calluses, corns, blisters and bunions right away.
Wear shoes when you are home instead of going barefoot or wearing socks.
New Cdc Campaign Highlights Steps To Prevent Injury In Adults Ages 65 And Over
Still Going Strong reminds older adults that getting older doesnât have to mean giving up the activities you enjoy
Contact:Media Relations 639-3286
The Centers for Disease Control and Prevention is launching Still Going Strong, a national campaign that brings attention to ways older adults can age without injury.
The campaign is raising awareness about the leading causes of unintentional injuries and deaths in older adults. Still Going Strong will encourage older adults to continue participating in their favorite hobbies and activities, while informing them and their caregivers of steps they can take to prevent injuries that disproportionately impact this populationfalls, motor vehicle crashes, and traumatic brain injury .
Experiencing injuries doesnt have to be a normal part of aging many injuries that are common in older adults can be prevented, said Debra Houry, MD, MPH, director of CDCs National Center for Injury Prevention and Control. We know that injuries and deaths from falls and motor vehicle crashes are increasing in older adults. We hope Still Going Strong will help inform our audience about simple steps they can do to prevent injuries and their lasting effects. Everyone has a roleolder adults, caregivers, loved ones, and healthcare providers. By taking proactive steps, you can prevent potentially life-changing injuries from happening and maintain your independence and mobility longer.
The prevalence of older adult injuries
Aging without injury
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Fall Prevention Is Key To Retaining Independence For Community
General older adult fall prevention resources, including guidelines, frameworks, reports and initiatives can be found at the following resource centers:
- Older Adult Falls : Webpage curated by CDC containing facts about falls, falls data by state, and fall prevention resources for clinicians, pharmacists, and older adults
- Falls Prevention Resources for Older Adults and Caregivers : Collection of fall prevention tips, programs, and resources from ACL and their partners.
- Fall Prevention Center of Excellence: Resources by Organization: List of fall prevention resources and supporting education materials from national organizations, state collaborations and international governments.
- National Falls Prevention Resource Center : This center supports the implementation and dissemination of evidence-based falls prevention programs and strategies.
Use Walkers And Canes
Walkers or canes can keep you as stable and safe as possible. However, choosing the right type for you is imperative.
Choose your gear with care. Dont use a walker or cane offered from someone else unless a professional such as a physical therapist has deemed it safe. What happens often is that someone dies, and their cane gets offered to another person. It then becomes a fall risk for that person because of an improper ft.
Consult with an occupational or physical therapist for an assessment of proper walking aids. Some folks are better off with walkers or canes that have wheels versus those that dont. There are also quad canes with four legs and those that are one leg.
Move your walker about one step in front of you. Ensure all legs touch the floor before you walk forward into the walker.
Use proper cane technique when dealing with stairs. This link from the Arthritis Foundation gives detailed information.
Keep an eye on your walker or canes rubber tips. Replace worn ones.
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Traumatic Brain Injury And Concussion
A traumatic brain injury, or TBI, is an injury that affects how the brain works. It may be caused by a bump, blow, jolt to the head, or a penetrating injury such as when an object enters the skull and harms the brain.
There are three main types of TBI:
- Mild TBI or concussion
Most TBIs that occur in older adults are mild TBIs or concussions.5
TBIs are preventable, but they remain a serious public health concern resulting in death and disability for thousands of older Americans each year. Older adults are more likely to have a hospital stay following a TBI compared to all other age groups.6
Falls and motor vehicle crashes are two of the leading causes of TBI-related hospitalizations among older adults.6 The good news is that you can lower your chance of getting a TBI by following steps to prevent a fall or motor vehicle crash.
TBIs may be missed in older adults
TBIs may be missed or misdiagnosed in older adults because symptoms of TBI overlap with other medical conditions that are common among older adults, such as dementia or when older adults have multiple injuries. Your healthcare provider should check you for signs and symptoms of TBI if you have fallen or were in a car crash.
This is especially important if you are taking blood thinners,7 such as:
- Anticoagulants such as warfarin , rivaroxaban , and apixaban
- Antiplatelet medications such as clopidogrel , ticagrelor , and acetylsalicylic acid
Get medical care for a TBI or concussion
Thinking and Remembering
What Causes Falls In Older Adults
Many things can cause a fall.
- Your eyesight, hearing, and reflexes might not be as sharp as they were when you were younger.
- Certain conditions, such as diabetes, heart disease, or problems with your thyroid, nerves, feet, or blood vessels can affect your balance and lead to a fall.
- Conditions that cause rushed movement to the bathroom, such as incontinence, may also increase the chance of falling.
- Older adults with mild cognitive impairment or certain types of dementia are at higher risk of falling.
- Age-related loss of muscle mass , problems with balance and gait, and blood pressure that drops too much when you get up from lying down or sitting are all risk factors for falling.
- Foot problems that cause pain, and unsafe footwear such as backless shoes or high heels, can also increase your risk of falling.
- Some medications can increase a persons risk of falling because they cause side effects such as dizziness or confusion. The more medications you take, the more likely you are to fall.
- Safety hazards in the home or community environment can also cause falls.
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Older Adult Fall Prevention
An older adult falls every second of every day.1 In adults aged 65 and older, most injuries, both fatal and non-fatal, are caused by falls.2 In 2018, 32,731 older adults died as result of a fall in the United States. 3 Falls are the leading cause of traumatic brain injuries and hip fractures among older adults. Serious injuries occur in nearly 20% of falls.4,5,6,7
Although falls affect older adults at a disproportionate rate, they are preventable. To address the health concerns of a rapidly aging society, the National Association of County and City Health Officials recognizes older adult fall prevention as a significant public health issue. With support from the Centers for Disease Control and Prevention , NACCHO is working on a project titled “Developing the Capacity to Support Older Adult Falls”. The project aims to help local health departments develop their capacity to identify older adults at high risk for falls, create awareness among older adults about fall risk and prevention, and partner with community resources to support LHDs fall prevention efforts.
Do Fall Risk Assessments
A fall risk assessment brings together all of the points touched on above. Such assessments consider the seniors home environment, any previous history of falls, medications the senior takes, the persons level of cognition, level of mobility, any incontinence issues that may lead to rushed movements, any depression issues and general health and foot health.
You can do a basic self-assessment or have a friend or relative do one for you. Professional caregivers, occupational therapists and physical therapists can also give assessments. If youre in the hospital for whatever reason, its possible one will be done there. Assessments are also common practice when you go into assisted living, nursing care and memory care.
After the assessment, a fall prevention plan can be developed for you. It may contain interventions like exercise program recommendations and recommendations for dealing with home hazards. The specific interventions vary with each person, of course.
If you want to set up a professional assessment for yourself or for a loved one, check with an occupational therapist. There may also be community resources such as care managers who specialize in helping older folks.
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Keeping Your Home Safe
Injuries can result from seemingly innocent things around your home many of which can be easily fixed or adapted. The home safety checklist will help you inspect your home for signs of trouble and find ways to fix them.
The Safe Living Guide is a home safety checklist to help you reduce the risk of injury in your home.
Take Care With Food Prep And Storage
Its possible to get injured from improper food prep and storage. To make sure that doesnt happen, you can:
Put leftovers in the refrigerator right away after a meal.
Keep your refrigerator temperature at or below 40 degrees Fahrenheit and your freezer temperature at 0 degrees Fahrenheit.
Throw food out if there is any doubt it could be unsafe.
Purchase pre-sliced food so you dont need to use a knife as often.
Keep vegetables and meats stored separately.
Label and date your leftovers.
Use red cutting boards for meats and green cutting boards for vegetables to avoid cross-contamination.
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Practice Commonsense Driving Techniques
Not driving when intoxicated and/or medicated
Taking the time to understand a new medications effect before driving
Seniors are also encouraged to drive during safe times. That is, its a good idea to limit or cut out your driving when its dusky, foggy, rainy, snowy or dark. Likewise, use caution when traffic is heavy or high-speed like it tends to be during rush hour and on interstates.
General tips for senior drivers include:
Driving vehicles with “smart” features that mean less physical exertion
Using public transportation if feasible
Having vision checked by a doctor regularly
Undergoing medication reviews regularly to check for interactions and side effects
Exercising to enhance flexibility and strength
Planning routes ahead of time and going to destinations with ample and easy parking
Giving more space than necessary to the traffic around you
Leaving earlier than you need to
Checking that the car fits you well
Taking a refresher course on driving, which might also reduce your insurance rates
Keep Your Bones Strong To Prevent Fall
Having healthy bones wont necessarily prevent a fall, but if you do fall, healthy bones may help prevent serious injury, such as breaking a hip or other bone. Bone breaks and fracture can lead to a hospital or nursing home stay, long-term disability, or even death. Getting enough calcium and vitamin D can help keep your bones strong. So can staying active. Try to get at least 150 minutes per week of physical activity.
Other ways to maintain bone health include quitting smoking and avoiding or limiting alcohol use. Tobacco and alcohol use may decrease your bone mass and increase your chance of fractures. Additionally, try to maintain a healthy weight. Being underweight increases the risk of bone loss and broken bones.
Osteoporosis is a disease that weakens bones, making them thin and brittle. For people with osteoporosis, even a minor fall may be dangerous. Talk to your doctor about osteoporosis.
Falls are a common reason for trips to the emergency room and for hospital stays among older adults. Many of these hospital visits are for fall-related fractures. You can help lower your risk of fractures by keeping your bones strong and following the tips above to avoid falls.
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