What are the main causes of falls in older adults. How can seniors reduce their risk of falling. What steps can be taken to fall-proof a home. How does exercise help prevent falls in the elderly. Why is it important for seniors to have regular vision and hearing tests. How do medications affect fall risk in older adults. What role does proper nutrition play in fall prevention for seniors.

Understanding the Prevalence and Impact of Falls in Older Adults

Falls among seniors are a significant health concern, affecting more than one in four individuals aged 65 and older each year. The consequences of these falls can be severe, often resulting in broken bones and potentially leading to long-term disability. As we age, the risk of falling and related complications increases, making fall prevention a crucial aspect of senior health care.

Despite the prevalence of falls, it’s important to note that many can be prevented through proactive measures. These include regular exercise, medication management, vision checks, and home safety modifications. By understanding the causes and implementing preventive strategies, seniors can maintain their independence and quality of life.

Identifying Common Causes of Falls in Seniors

Several factors contribute to the increased risk of falls among older adults:

• Declining sensory functions (eyesight, hearing, and reflexes)
• Chronic health conditions (diabetes, heart disease, thyroid problems)
• Balance and gait issues
• Cognitive impairment
• Muscle loss (sarcopenia)
• Postural hypotension
• Foot problems and inappropriate footwear
• Medication side effects
• Environmental hazards

Understanding these risk factors is the first step in developing effective fall prevention strategies. By addressing each of these areas, seniors can significantly reduce their likelihood of experiencing a fall.

The Role of Physical Activity in Fall Prevention

Maintaining an active lifestyle is crucial for fall prevention in seniors. Regular exercise helps improve muscle strength, flexibility, and balance, all of which are essential for preventing falls. But how exactly does physical activity contribute to fall prevention?

• Strengthens muscles, particularly in the legs and core
• Improves balance and coordination
• Enhances flexibility and range of motion
• Boosts overall cardiovascular health
• Helps maintain bone density, reducing fracture risk if a fall occurs

Engaging in a variety of exercises can provide comprehensive benefits. Walking, for instance, is a low-impact activity that improves cardiovascular health and leg strength. Balance-specific exercises, such as standing on one foot or heel-to-toe walks, can enhance stability. Strength training with weights or resistance bands builds muscle mass and bone density.

Recommended Exercises for Seniors

1. Tai Chi: Known for its slow, controlled movements, Tai Chi is excellent for improving balance and body awareness.
2. Yoga: Promotes flexibility, strength, and balance while also reducing stress.
3. Pilates: Focuses on core strength, which is crucial for maintaining balance and proper posture.
4. Water aerobics: Provides resistance training with minimal impact on joints.
5. Chair exercises: Ideal for those with limited mobility, these exercises can improve strength and flexibility.

Is it ever too late to start exercising? The answer is a resounding no. Even seniors who have never exercised regularly can benefit from starting a gentle, supervised exercise program. It’s essential to consult with a healthcare provider before beginning any new exercise regimen to ensure safety and appropriateness.

Creating a Fall-Proof Home Environment

The home environment plays a crucial role in fall prevention for seniors. Many falls occur due to hazards that can be easily addressed with some simple modifications. How can you make a home safer for older adults?

• Remove clutter and loose rugs from walkways
• Install handrails on both sides of staircases
• Ensure adequate lighting throughout the home, especially in hallways and stairwells
• Place non-slip mats in bathrooms and showers
• Arrange furniture to create clear pathways
• Keep frequently used items within easy reach
• Consider installing grab bars in bathrooms and near toilets
• Ensure outdoor walkways are well-lit and free of hazards

Are there specific areas of the home that require extra attention? The bathroom and kitchen are often high-risk areas for falls. In the bathroom, consider installing a raised toilet seat and using a shower chair. In the kitchen, ensure that frequently used items are stored at waist level to avoid excessive reaching or bending.

The Importance of Regular Health Check-ups in Fall Prevention

Regular health check-ups play a vital role in fall prevention for seniors. These assessments allow healthcare providers to identify and address potential risk factors before they lead to falls. What specific health checks are most important for fall prevention?

Vision and Hearing Tests

Even minor changes in vision or hearing can significantly increase fall risk. Regular eye exams can detect issues like cataracts, glaucoma, or the need for updated prescriptions. Hearing tests are equally important, as inner ear problems can affect balance.

Medication Reviews

As we age, the number of medications we take often increases. Some medications, or combinations of medications, can cause side effects like dizziness or drowsiness, increasing fall risk. Regular medication reviews with a healthcare provider or pharmacist can help identify and mitigate these risks.

Bone Density Scans

Osteoporosis, a condition that weakens bones, increases the risk of fractures if a fall occurs. Regular bone density scans can detect osteoporosis early, allowing for preventive treatment.

Balance and Gait Assessments

Healthcare providers can perform specific tests to evaluate a senior’s balance and gait. These assessments can identify issues early and guide appropriate interventions, such as physical therapy or the use of assistive devices.

How often should seniors undergo these health checks? While it can vary based on individual health status, most experts recommend annual comprehensive health assessments for older adults, with more frequent check-ups for those with chronic conditions or identified fall risks.

The Impact of Nutrition on Fall Prevention

Proper nutrition plays a crucial role in fall prevention for seniors, yet it’s often overlooked. How does diet contribute to reducing fall risk?

• Adequate protein intake helps maintain muscle mass and strength
• Calcium and Vitamin D support bone health, reducing fracture risk if a fall occurs
• Proper hydration helps maintain blood pressure and prevents dizziness
• B vitamins support nerve function and balance
• Antioxidants from fruits and vegetables support overall health and cognitive function

What specific dietary recommendations can help seniors reduce their fall risk? A balanced diet rich in lean proteins, whole grains, fruits, vegetables, and low-fat dairy can provide the necessary nutrients. Specific recommendations include:

1. Consuming at least 1-1.2 grams of protein per kilogram of body weight daily
2. Ensuring adequate calcium intake (1200 mg daily for women over 50 and men over 70)
3. Getting sufficient Vitamin D (800-1000 IU daily for most seniors)
4. Staying hydrated by drinking at least 8 glasses of water daily
5. Limiting alcohol consumption, as it can affect balance and increase fall risk

Are there any specific foods that are particularly beneficial for fall prevention? Foods rich in omega-3 fatty acids, such as fatty fish, walnuts, and flaxseeds, have anti-inflammatory properties that may help maintain muscle and bone health. Additionally, foods high in antioxidants, like berries and leafy greens, support overall health and cognitive function.

The Role of Assistive Devices in Fall Prevention

Assistive devices can play a crucial role in fall prevention for seniors by providing additional support and stability. However, it’s essential to use these devices correctly to maximize their benefits. What are some common assistive devices for fall prevention?

• Canes
• Walkers
• Grab bars
• Raised toilet seats
• Shower chairs
• Stairlifts

How do you choose the right assistive device? The selection should be based on individual needs and abilities, typically under the guidance of a healthcare professional such as a physical therapist or occupational therapist. Factors to consider include:

1. The user’s physical condition and mobility level
2. The specific activities the device will be used for
3. The home environment
4. The user’s comfort and willingness to use the device

Is it necessary to receive training to use assistive devices properly? Absolutely. Improper use of assistive devices can actually increase fall risk. For example, a cane that’s too tall or too short can affect balance rather than improve it. Physical or occupational therapists can provide training on proper use, including:

• Correct posture and positioning when using the device
• Proper technique for walking with a cane or walker
• How to navigate different terrains and obstacles
• Maintenance and safety checks for the device

Regular reassessment of the need for and appropriateness of assistive devices is also important, as an individual’s needs may change over time.

The Impact of Medications on Fall Risk

Medications play a crucial role in managing various health conditions in seniors, but they can also significantly impact fall risk. How do medications increase the likelihood of falls?

• Some medications can cause dizziness or lightheadedness
• Certain drugs may affect balance or coordination
• Some medications can cause drowsiness or confusion
• Diuretics can lead to dehydration and electrolyte imbalances, affecting balance
• Blood pressure medications may cause postural hypotension

Which types of medications are most commonly associated with increased fall risk? While any medication can potentially contribute to fall risk, some categories are more frequently implicated:

1. Sedatives and sleep medications
2. Antidepressants
3. Antipsychotics
4. Antihistamines
5. Blood pressure medications
6. Opioid pain relievers
7. Diabetes medications, particularly those that can cause low blood sugar

How can seniors and their caregivers manage medication-related fall risks? Several strategies can help:

• Regular medication reviews with healthcare providers or pharmacists
• Keeping an up-to-date list of all medications, including over-the-counter drugs and supplements
• Reporting any side effects or concerns to healthcare providers promptly
• Asking about potential alternatives if a medication is causing problematic side effects
• Taking medications exactly as prescribed and at the right times
• Using pill organizers or other medication management tools to ensure proper dosing

Is it possible to reduce fall risk while still taking necessary medications? In many cases, yes. Healthcare providers can often adjust dosages, change timing of doses, or switch to alternative medications to reduce fall risk while still managing underlying health conditions effectively. It’s crucial for seniors to maintain open communication with their healthcare team about any concerns or side effects they experience.

The Psychological Aspects of Fall Prevention

While physical factors play a significant role in fall prevention, the psychological aspects are equally important. Fear of falling is a common concern among older adults, even those who haven’t experienced a fall. How does fear of falling impact seniors?

• It can lead to reduced physical activity
• It may cause social isolation
• It can result in a loss of confidence and independence
• It may increase anxiety and depression
• Paradoxically, it can actually increase fall risk by causing tentative movements

How can seniors overcome fear of falling? Several strategies can help:

1. Participating in fall prevention programs that combine education with exercise
2. Engaging in activities that improve balance and strength, boosting confidence
3. Using cognitive behavioral therapy techniques to address fear and anxiety
4. Joining support groups to share experiences and coping strategies
5. Gradually increasing activity levels with support from healthcare professionals

Is there a connection between cognitive health and fall risk? Indeed, cognitive function plays a crucial role in fall prevention. Cognitive impairment, even mild, can increase fall risk by affecting judgment, spatial awareness, and reaction time. Strategies to maintain cognitive health include:

• Engaging in mentally stimulating activities like puzzles or learning new skills
• Maintaining social connections
• Getting regular physical exercise, which benefits both physical and cognitive health
• Managing chronic health conditions that can affect cognitive function
• Ensuring adequate sleep and nutrition

By addressing both the physical and psychological aspects of fall prevention, seniors can maintain their independence, confidence, and quality of life. It’s important to remember that fall prevention is not about limiting activities, but about finding safe ways to stay active and engaged.

Falls and Fractures in Older Adults: Causes and Prevention

Español

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.

On this page:

If you or an older adult in your life has fallen, you’re 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 haven’t 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 don’t 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.

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 (known as sarcopenia), problems with balance and gait, and blood pressure that drops too much when you get up from lying down or sitting (called postural hypotension) 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 person’s 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.

Steps to take to prevent falls

If you take care of your overall health, you may have a lower chance of falling. Most of the time, falls and accidents don’t just happen for no reason. Here are a few tips to help lessen your risk of falls and broken bones, also known as fractures:

Read and share this infographic and help spread the word about how to help prevent falls.

• Stay physically active. Plan an exercise program that is right for you. Regular exercise improves muscles and makes you stronger. Exercise also helps keep your joints, tendons, and ligaments flexible. Mild weight-bearing activities, such as walking or climbing stairs, may slow bone loss from osteoporosis, a disease that makes bones weak and more likely to break
• Try balance and strength training exercises. Yoga, Pilates, and tai chi can all improve balance and muscle strength. You can also try lifting weights or using resistance bands to build strength. Learn more about different types of exercises to improve balance and strength.
• Fall-proof your home. Check out these tips for changes you can make to your home that will help you avoid falls and ensure your safety.
• Have your eyes and hearing tested. Even small changes in sight and hearing are linked to an increased risk for falls. When you get new eyeglasses or contact lenses, take time to get used to them. Wear your glasses or contacts as your eye doctor advises. If you have a hearing aid, be sure it fits well and wear it.
• Find out about the side effects of any medicines you take. If a drug makes you sleepy or dizzy, tell your doctor or pharmacist.
• Get enough sleep. If you are tired, you are more likely to fall.
• Avoid or limit alcohol. Too much alcohol can lead to balance problems and falls, which can result in hip or arm fractures and other injuries.
• Stand up slowly. Getting up too quickly can cause your blood pressure to drop. That can make you feel wobbly. Get your blood pressure checked when lying and standing.
• Use an assistive device if you need help feeling steady when you walk. Using canes and walkers correctly can help prevent falls. If your doctor tells you to use a cane or walker, make sure it’s the right size for you. Walker wheels should roll smoothly. If you borrow walking support equipment from a friend, ask your health care provider to make sure the equipment is the correct size and is safe to use. This is exceptionally important when you’re walking in areas you don’t know well or where the walkways are uneven. A physical or occupational therapist can help you decide which devices might be helpful and teach you how to use them safely.
• Take extra caution when walking on wet or icy surfaces. These can be very slippery! Use an ice melt product or sand to clear icy areas by your doors and walkways.
• Keep your hands free. Use a shoulder bag, fanny pack, or backpack to leave your hands free to hold on to railings.
• Choose the right footwear. To fully support your feet, wear nonskid, rubber-soled, low-heeled shoes. Don’t walk on stairs or floors in socks or in shoes and slippers with smooth soles.
• Consider staying inside when the weather is bad. Some community services provide 24-hour delivery of prescriptions and groceries, and many take orders over the phone.
• Always tell your doctor if you have fallen since your last check-up, even if you did not feel pain when you fell. A fall can alert your doctor to a new medical problem or issues with your medications or eyesight that can be corrected. Your doctor may suggest physical therapy, a walking aid, or other steps to help prevent future falls.

What to do if you fall

Whether you are at home or somewhere else, a sudden fall can be startling and upsetting. If you do fall, stay as calm as possible and take the following steps:

• Breathe. Take several deep breaths to try to relax. Remain still on the floor or ground for a few moments. This will help you get over the shock of falling.
• Decide if you are hurt. Getting up too quickly or in the wrong way could make an injury worse.
• Crawl to a sturdy chair. If you think you can get up safely without help, roll over onto your side. Rest again while your body and blood pressure adjust. Slowly get up on your hands and knees, and crawl to a sturdy chair.
• Slowly sit down in the chair. Put your hands on the chair seat and slide one foot forward so that it’s flat on the floor. Keep the other leg bent so the knee is on the floor. From this kneeling position, slowly rise and turn your body to sit in the chair.
• Get help. If you are hurt or cannot get up on your own, ask someone for help or call 911. If you are alone, try to get into a comfortable position and wait for help to arrive. Prepare for a fall by keeping a well-charged cordless or mobile phone with you at all times and arrange for daily contact with a family member or friend. Emergency response systems are another option: These systems enable you to push a button on a special necklace or bracelet to call for help. Some smartwatches also have this feature.

Keep your bones strong to prevent fall-related fractures

Having healthy bones won’t 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.

For more information

Centers for Disease Control and Prevention (CDC)
800-232-4636
888-232-6348 (TTY)
[email protected]
www.cdc.gov

National Resource Center on Supportive Housing and Home Modifications
213-740-1364
homemods@usc. edu
www.homemods.org

Rebuilding Together
800-473-4229
[email protected]
www.rebuildingtogether.org

National Falls Prevention Resource Center
571-527-3900
www.ncoa.org/center-for-healthy-aging/falls-resource-center/

This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.

Content reviewed:
September 12, 2022

Related Articles

Preventing Falls at Home: Room by Room

Many falls happen at home, where we spend much of our time and tend to move around without thinking about our safety. There are many changes you can make to your home that will help prevent falls and better ensure your safety.

On this page:

Floors, stairways, and hallways

• Ensure there are handrails on both sides of any stairs, and make sure they are secure. Hold the handrails when you go up or down stairs, even when you are carrying something. Don’t let anything you’re carrying block your view of the steps.
• Ensure there is good lighting with light switches at the top and bottom of stairs and on each end of a long hall. Consider using motion-activated lights that plug into electrical outlets and automatically turn on when you walk by them to help illuminate stairwells and pathways.
• Keep areas where you walk tidy. Don’t leave books, papers, clothes, or shoes on the floor or stairs.
• Check that all carpets are fixed firmly to the floor, so they won’t slip. Put no-slip strips, which you can buy at any hardware store, on tile and wooden floors.
• Don’t use throw rugs or small area rugs.
• Don’t walk on slippery, newly washed floors.

Bathrooms

• Mount grab bars near toilets and on both the inside and outside of your tub and shower.
• Place nonskid mats, strips, or carpet on all surfaces that may get wet.
• Remember to leave a light on in the bathroom at night or use a night light that turns on automatically in the dark.

Bedrooms

• Put night lights and light switches close to your bed.
• Keep a flashlight by your bed in case the power goes out and you need to get up.
• Place a landline or well-charged phone near your bed.

Kitchen

• Keep frequently used pots, pans, and kitchen utensils in a place where they are easy to reach.
• Clean up spills immediately.
• Prepare food while seated to prevent fatigue or loss of balance.

Outdoor spaces

• If you have steps leading to your front door, make sure they are not broken or uneven.
• Add non‐slip material to outdoor stairways.
• Keep the lawn, deck, or porch areas clear of debris, such as fallen branches.
• Consider installing a grab bar near the front door to provide balance while you are locking or unlocking the door.
• Turn on your porch light at night and if you leave during the day but plan on returning home after dark.
• In the winter, treat outdoor walkways with an ice melt product or sand to make them less slippery.

Other living areas

• Keep electrical cords near walls and away from walking paths.
• Arrange your furniture (especially low coffee tables) and other objects so they are not in your way when you walk.
• Make sure your sofas and chairs are the right height for you to get in and out of easily.
• Keep items you use often at waist level or within easy reach.
• Don’t stand on a chair or table to reach something that’s too high — use a “reach stick” instead or ask for help. Reach sticks are special grabbing tools that you can buy at many hardware or medical-supply stores. If you use a step stool, make sure it’s steady and has a handrail on top. Have someone stand next to you.
• Don’t let your cat or dog trip you. Know where your pet is whenever you’re standing or walking.
• Keep a list of emergency numbers in large print near each landline phone and save them under “favorites” on your mobile phone.

If you have fallen, your doctor might suggest that an occupational therapist, physical therapist, or nurse visit your home. These health care providers can assess your home’s safety and advise you about making changes to lower your risk of falls.

Tools to get help

Read and share this infographic and help spread the word about how to help prevent falls.

If you’re concerned about falling, set up systems to ensure you can get help if you fall. One option is installing an emergency response system. If you fall or need emergency help, you push a button on a special necklace or bracelet to alert 911. There is a fee for this service, and it’s usually not covered by insurance.

Another option is to carry a well-charged cordless or mobile phone with you as you move throughout the house. Have close friends and family on speed dial. Consider setting up a smart home device (a small speaker that listens and responds to commands when you call its name) that can quickly connect you to contacts or emergency response teams. Some smartwatches can be set up to make emergency calls at the push of a button and others can even detect sudden fall-like movements and automatically call for help. Ask family and friends for help setting up these tools.

Home improvement resources

Many state and local governments have education and/or home modification programs to help older people prevent falls. Check with your local health department, search the Eldercare Locator, or call 800-677-1116 to find your local Area Agency on Aging to see if there is a program near you.

Read more about falls and falls prevention.

Read about this topic in Spanish. Lea sobre este tema en español.

For more information

National Resource Center on Supportive Housing and Home Modifications
213-740-1364
homemods@usc. edu
www.homemods.org

Rebuilding Together
800-473-4229
[email protected]
www.rebuildingtogether.org

Centers for Disease Control and Prevention (CDC)
800-232-4636
888-232-6348 (TTY)
[email protected]
www.cdc.gov

National Center for Injury Prevention and Control                                                                                                           
Centers for Disease Control and Prevention
800-232-4636
888-232-6348 (TTY)
[email protected]
www.cdc.gov/injury

National Falls Prevention Resource Center
571-527-3900
www.ncoa.org/center-for-healthy-aging/falls-resource-center/

This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.

Content reviewed:
September 12, 2022

Related Articles

Falls in the elderly – causes, symptoms, diagnosis and treatment

Falls in the elderly is a geriatric syndrome, the main clinical symptom of which is the case when a person over 60 years of age inadvertently suddenly finds himself on the floor or ground. Concomitant symptoms depend on the existing background diseases. Diagnosis of the causes of the syndrome is carried out using laboratory tests, radiography, ECG, Holter monitoring, and neuroimaging. Therapy includes drug correction of the background pathology, the appointment of vitamin D preparations, an individual exercise therapy program, and, if necessary, psychotherapy.

General information

Falls in the elderly are a leading gerontological problem affecting the prognosis and quality of life of patients. This syndrome does not include cases that arose as a result of exposure to mechanical factors (for example, a blow), epileptic seizure, loss of consciousness, sudden paralysis. According to studies, among people over 65 years of age, 33% indicate a history of falls, half of them have such cases more than once a year. In the elderly, falls are the leading cause of injury and the number one cause of death from injury.

Falls in the elderly

Causes

The main etiological factors are irreversible age-related changes in the body and environmental conditions. The psychological characteristics of old age also play a significant role. A combination of several etiological factors increases the likelihood of a fall. All etiological causes are divided into 2 groups: internal and external. The first are due to the physical and mental state of a person. These include:

• Age-associated changes. The occurrence of the syndrome is facilitated by age-related impairments of vision, hearing, and the motor apparatus. Changes in the nervous system lead to a reduced reaction rate, a decrease in attentiveness.
• Diseases of organs and systems. From the side of the central nervous system, this is Parkinson’s disease, cerebral circulation disorders, degenerative processes. Among other diseases, falls can be provoked by: anemia, myocardial infarction, arrhythmias, deformities of the spinal column, diarrhea.
• Psycho-emotional disorders. Anxiety, depression, fear of falling lead to restlessness, irrational behavior that increases the chances of falling. A favorable background for the occurrence of pathology is nervous exhaustion.
• Iatrogenic causes. Increased tendency to fall may be associated with limb immobilization, polypharmacy. The appointment of sedatives, tranquilizers entails inhibition of reactions, drowsiness, inattention, which increase the likelihood of falling.
• Behavioral factors. Includes bad habits, lack of sufficient physical activity. Uncontrolled self-administration of a large number of medications changes the state of the body in the direction of increasing the risk of falling.

External etiofactors affect a person from the outside. They are due to the environment, various social reasons. Among the external factors, the following are distinguished:

• Environmental. The environment around an elderly person can provoke a loss of balance. For example, uneven pavement, holes in the sidewalk, stairs that are too high or narrow. For the elderly, it is difficult to move in poor or too bright lighting, on slippery surfaces.
• Social. The isolation of the elderly from society, living alone lead to a lack of support and assistance in the improvement, medical care. Economic problems entail reduced nutrition, which can cause asthenia.

Pathogenesis

The fall occurs due to the inability to maintain balance when the center of gravity shifts. This prevents the work of the vestibular and musculoskeletal system. Normally, the body position is maintained due to the tension of the muscles of the lower extremities, step response or reliance on surrounding objects.

After the age of 30, there is a gradual decrease in the number of muscle fibers and muscle strength, which leads to muscle weakness in the elderly. Sarcopenia develops, more pronounced in relation to fast muscle fibers. Decreased mobility of the ligamentous apparatus, range of motion in the joints. As a result, the possibility of a quick muscular reaction to maintain balance suffers.

In the elderly step response, a short forward step is followed by an additional step to the side. Small steps cause one foot to touch another. This change in gait pattern leads to frequent falls to the side, with the risk of injury to the hip joint and fracture of the femoral neck.

Falls in the elderly

Classification

Currently, fall syndrome in the elderly is classified based on 2 criteria: the causative factor and the presence of injury. Etiopathogenetic classification is necessary for the statistics of causes with the subsequent implementation of preventive measures. According to her, the fall is divided into:

• Random. Associated with environmental causes. Includes stumbling over obstacles, underestimating the location of surrounding objects. One of the reasons is the darkness of the room.
• Predictable. Associated with the physiological state of the patient. The probability of falling is higher in patients with dizziness, muscle weakness, parkinsonism, cognitive impairment.
• Unpredictable. The patient falls due to an unpredictable pathological condition. Unpredictable causes are heart attack, stroke, hypoglycemic episode, syncope.

Classification of the syndrome according to emerging traumatic complications and their severity is of clinical importance. It is necessary to determine the further tactics of the patient. There are 2 main groups:

• Falls without injury. Not accompanied by visible damage and complaints. In some cases, X-ray, tomography, and other instrumental studies are necessary to exclude damage.
• Falls with injury. Includes cases resulting in injury to the victim. The mild degree is characterized by the presence of bruises and abrasions, the middle degree is characterized by the occurrence of sprains, wounds that need to be sutured. The severe degree includes fractures, craniocerebral injuries, damage to internal organs.

Symptoms of falls in the elderly

Clinical symptoms depend on the premorbid background and the severity of the injuries. Characterized by complaints of uncertainty walking, instability, dizziness, weakness in the legs. Voluntary movements are slowed down, there is a shortening of the stride length, a shuffling gait is possible. The frequency of falls, the circumstances under which they occur, are different. Elderly patients with mnestic disorders may not remember falling. Such an incident is evidenced by the fear of falling, which they still have.

Recurrent falls in an elderly patient usually follow a similar pattern. With orthostatic hypotension, atonic seizure, arrhythmias, the patient literally “falls” to the floor. In parkinsonism, the loss of balance occurs when the position of the body changes, after freezing. Weakness of the muscles of the foot, spastic muscle hypertonicity of the feet are characterized by unbalanced balance after stumbling. In the case of senile dementia, psycho-emotional disorders, a clear pattern is not traced.

Complications

Falls in the elderly lead to serious injury in 10-15% of cases. Damage to tendons and ligaments, fractures of the lower leg, thigh, upper limb, and ribs are possible. The most common cause of hip fractures is due to a violation of the stepping pattern. Given the slowness of regenerative processes in the elderly, the consolidation of the fracture is difficult and not always successful. When hitting the head, a concussion, brain contusion, and the formation of a subdural hematoma are possible. Severe cerebral injury can be fatal.

Diagnostics

Identification of patients at risk is carried out by questioning when applying on an outpatient basis, during hospitalization. The diagnosis is established according to two criteria: the presence of the fact of a fall in an elderly person, the exclusion of the connection of the incident with epileptic paroxysm, stroke, loss of consciousness. A wide examination is shown to identify internal etiological factors with a view to their subsequent correction. Diagnostic measures include:

• Neurological examination. In the neurological status, attention is paid to a decrease in muscle strength, unsteady gait, instability in the Romberg position, and cognitive deviations. In practical neurology, additional tests are used: getting up from a chair, standing on one leg, standing in a tandem position.
• Laboratory diagnostics. Recommended complete blood count with determination of hemoglobin level, urinalysis. The functional state of the kidneys is assessed by the level of creatinine, glomerular filtration rate. A study of thyroid hormones is prescribed.
• Cardiac examination . Includes measurement of pressure, heart rate, mandatory ECG. In the diagnosis of arrhythmias, Holter monitoring is used. If indicated, consultation with a cardiologist is recommended.
• Bone X-ray . It is carried out if a fracture is suspected in order to assess the condition of the musculoskeletal system. If more detailed visualization is required, CT of the hip joint and spine is recommended.
• Ultrasound of the vessels of the head and neck. Indicated for the evaluation of cerebrovascular hemodynamics, disorders of which act as triggers for falls in the elderly. If necessary, the study is supplemented by angiography.
• MRI of the brain. Recommended for assessing the state of cerebral structures, identifying atrophic and degenerative changes. It is used in the course of differential diagnosis with space-occupying formations.

Differential diagnosis

Falls in the elderly should be differentiated from intracranial neoplasms. The latter manifest with cerebral symptoms, which are also possible in old age. Differential diagnosis is carried out by the presence of focal symptoms (paresis, sensory disorders, speech disorders), visualization of the neoplasm on cerebral CT / MRI.

Use of supportive aids

Treatment of falls in the elderly

Patients are advised to exercise according to their functional abilities. An important point is the observance of a complete diet, with the use of food rich in protein, trace elements, vitamins. Therapy is carried out in a complex manner using all possible methods. In case of arrhythmia, the question of the expediency of installing a pacemaker is considered. The basic elements of treatment are:

1. Drug therapy. Aimed at correcting identified concomitant diseases acting as individual triggers. Particular attention is paid to the exclusion of polypharmacy. With a deficiency of vitamin D, its additional intake is indicated.
2. Therapeutic exercise. A set of exercises is individually selected to strengthen the muscles of the limbs, train the vestibular apparatus, and improve coordination of movements. Recommended daily exercise.
3. Psychotherapy. Cognitive-behavioural, psychoanalytic techniques help older patients overcome their fear of falling. Improvement of attentiveness, mnestic functions is facilitated by special cognitive training.

Prognosis and prevention

The lack of qualified medical care leads to repeated episodes of incontinence in the elderly, injuries, severe complications with loss of autonomy. The results of treatment depend on age, degree of functional activity, comorbidities. Fall-related mortality in the 65-year-old age group is about 50 per 100,000 and steadily increases with age.

Primary prevention of falls in the elderly includes an active lifestyle, a nutritious diet, regular exercise, and timely treatment of emerging diseases. Secondary prevention is carried out by creating safe conditions in the place of residence (selection of stable furniture, installation of handrails, lighting correction), selection of comfortable shoes, wearing special orthoses, individually selected insoles.

Injury prevention in the elderly.

Injuries pose a serious threat to the health and life of people of all ages. Every year, millions of people around the world, due to personal carelessness and negligence, or due to someone else’s criminal negligence and irresponsibility, are injured, become disabled, lose their lives.

Injuries are not uncommon in the elderly. The causes of these injuries can be divided into internal and external.

Internal causes are associated with age-related changes in the musculoskeletal system, organs of vision and the cardiovascular system.

External causes are related to improper organization of safe movement, low security of the home, uncomfortable shoes, lack of auxiliary means of movement (canes, walkers), etc.

In the elderly and senile age, problems with gait appear against the background of neurological and vascular diseases, pathologies of the musculoskeletal system: muscle atrophy, joint pain, loss of their flexibility.

Taking many drugs, especially several at the same time, changes the state of vascular tone, which often leads to a fall.

The risk of falling is high in people who are little (no more than 4 hours a day) in an upright position, as well as in those who cannot sit down and stand up without help, who are in a depressed, depressed state, in those who suffers from syncope (short-term blackouts of consciousness).

Of no small importance are such factors as ice in winter, uneven road surface, poor lighting, lack of assistance from people who need it, etc.

In 50% of cases, falls occur at home, especially in the bathroom and bedroom. Many older people get injured without witnesses, depriving them of quick help.

Treatment of the consequences of serious injuries received under various circumstances is expensive for both the patient and his family. A person has to go through a mental trauma: to regain confidence in their physical strength, to overcome the fear of repeated falls. The consequences of fractures are often a loss of independence, the need to hire a nurse, ask for help from relatives and friends. The restriction of the ability to move makes the convalescent lie down for a long time, which adversely affects his well-being: constipation, bedsores occur, due to age-related violations of thermoregulation – hypothermia and pneumonia. These patients often develop depression, suicidal thoughts.

During such a period, attention and care for the victim of his relatives and friends is especially important.

Recommendations for the elderly on injury prevention.

Prevention of injuries, falls, injuries in old age largely depends on the person himself, his lifestyle, behavior and attention. In this regard, it is recommended:

• Timely detection and treatment of cardiovascular diseases, arthrosis, osteoporosis.
• Periodic vision and hearing checks should be made to order stronger glasses or hearing aids in a timely manner.
• Performing at home exercises for balance and muscle training as prescribed by a doctor, as well as daily walking.
• Maintaining the optimal temperature in the living room, since its significant changes worsen the blood supply to the brain, which leads to impaired coordination of movements.
• Regular walks, swimming, light gymnastics help to maintain vigor and mobility.
• It is undesirable to leave the house at night, in very cold weather, when it is snowing and slippery. In winter, to prevent falls while walking, it is advisable to use a cane or walk accompanied by loved ones, this is especially important when crossing the street, when descending and climbing stairs.
• When returning home at night, it is desirable to accompany acquaintances or friends, while choosing a route through crowded and illuminated places.
• It is important to choose the right shoes. It should be loose, but not too large, soft and with grooved soles.