How can older adults prevent falls? What are the common factors that lead to falls among seniors? Where can seniors find resources and assistance for fall prevention?

Understanding the Impact of Falls on Older Adults

Falls are a serious issue for the elderly population, as they are the single largest cause of death and injuries in older Americans. Around 33% of the elderly fall at least once per year, and these falls result in over 2 million visits to the emergency room. Falls are the most common cause of traumatic brain injuries in older adults and can also lead to severe injuries such as hip fractures, which can have a significant negative impact on quality of life and the economy. In 2010, the direct cost of falls to society was around $30 billion.

Debunking Myths About Falls and the Elderly

There are numerous myths surrounding falls and the elderly, which can hinder effective fall prevention efforts. The first step in fall prevention is to learn the truth and dispel these myths:

• Myth: Men are more likely to suffer a fatal injury from a fall due to their more physical lifestyle. Reality: Women are more likely to fall and suffer serious injury or death from a fall.
• Myth: If you are elderly, then you will fall – expect it. Reality: Seniors can expect and work toward a life free of falls with the proper care.
• Myth: There is no systemic approach or assistance that can help older adults avoid falls in their homes. Reality: Government agencies and organizations provide fall prevention strategies and tools for assessing fall risk.
• Myth: A fall, especially a serious fall, means the end of a person’s ability to live independently with dignity. Reality: The cause of the fall must be determined, and if it can be fixed with a fall prevention plan, there is no reason the older adult cannot continue living a healthy, independent lifestyle.
• Myth: Falls only occur because of muscle deterioration or failing health. Reality: A variety of factors, such as vision problems, medications, and poor lighting, can contribute to falls.

Common Factors that Lead to Falls Among Seniors

While health can be a contributing factor to falls, it is not the only contributor. Knowing the variety of factors behind falls can make it easier to avoid them.

Medical Conditions

Older adults may suffer from one or more chronic medical conditions, which can increase the risk of falling even when controlled. Medications, both prescription and over-the-counter, can also cause side effects like dizziness or mental instability that can lead to falls. It’s important to discuss any medical conditions or medications with a doctor to identify and address potential fall risks.

Physical Limitations

Physical limitations, such as vision problems or the loss of a limb, can increase the risk of falls. However, with the proper fall prevention strategies, these limitations can be effectively managed to eliminate falling risks.

Environmental Factors

The home environment can also create falling hazards, such as clutter, poor lighting, or slippery surfaces. Identifying and addressing these environmental factors is crucial for fall prevention.

Resources and Assistance for Fall Prevention

Fortunately, there are various resources and assistance available to help older adults prevent falls and maintain their independence and quality of life. The CDC and other organizations provide official lists of fall prevention strategies and tools for assessing fall risk. Additionally, government agencies are taking the issue of falls among the elderly more and more seriously, offering support and guidance for seniors and their caregivers.

Developing a Comprehensive Fall Prevention Plan

Preventing falls in the elderly requires a multi-faceted approach that addresses the various factors that can contribute to falls. This includes working closely with healthcare providers to manage medical conditions and medications, implementing home modifications to address environmental hazards, and engaging in regular physical activity to maintain strength and balance. By taking a proactive and comprehensive approach to fall prevention, older adults can reduce their risk of falls and continue living healthy, independent lives.

The Importance of Ongoing Fall Prevention Efforts

Preventing falls in the elderly is an ongoing process that requires vigilance and a commitment to maintaining a safe and healthy lifestyle. Regular checkups with healthcare providers, continued home assessments, and a dedication to physical activity and fall prevention strategies are all essential for reducing the risk of falls and ensuring the well-being of older adults. By staying informed and proactive, seniors and their caregivers can work together to create a fall-free future.

Preventing Falls in Older Adults – Aging.com

Falls are the single largest cause of death and injuries in older Americans. Around 33% of the elderly fall at least once per year, and these falls result in over 2 million visits to the emergency room. Falls are the most common cause of traumatic brain injuries in older adults, and they may also cause other severe injuries, such as fractures of the hip, that can have extremely negative impacts on quality of life—and on our economy in general. The direct cost of falls to society was around $30 billion in 2010.

As daunting as these statistics are, they don’t take into account the psychological effects of a fall. Seniors who fall can become more afraid of falling, and this fear can reduce their quality of life and their ability to exercise properly. Reduced physical activity can then lead to a vicious cycle in which a older person’s physical condition deteriorates, increasing the risk of falling even more, and further curtailing the victim’s independence and quality of life. For these reasons and others, fall prevention is an essential component of senior care.

Myths About Falls and the Elderly

Numerous myths surround falls and the elderly. For that reason, the first step in fall prevention is to learn the truth.

Myth No. 1 – Because they have a more physical lifestyle, men are more likely to suffer a fatal injury from a fall. The truth is actually the opposite. Women are more likely to fall, and are also more likely to suffer serious injury or death from a fall.

Myth No. 2 – If you are elderly, then you will fall – expect it. This is untrue. Seniors should expect—and work toward—a life free of falls. The National Council on Aging has concluded that with the proper care, a senior adult can expect to live a full, healthy, fall-free lifestyle.

Myth No. 3 – There is no systemic approach or assistance that can help older adults avoid falls in their homes. The truth is that government agencies are taking the issue more and more seriously. The CDC and other organizations now provide official lists of fall prevention strategies and even tools for assessing fall risk.

Myth No. 4 – A fall, especially a serious fall, means the end of a person’s ability to live independently with dignity. Nothing could be further from the truth. The cause of the fall must first be determined. If the cause can be fixed and a fall prevention plan put into place, there is no reason that an older adult cannot continue living a robust, healthy, independent lifestyle.

Myth No. 5 – Falls only occur because of muscle deterioration or failing health. The truth is that a variety of factors lead to falls. Many falls actually occur because of vision problems, medications that cause dizziness or mental instability, poor lighting, and other factors.

To learn more about the true facts about falls, view our Falls Fact Sheet.

Common Factors That Lead To Falls Among Seniors

As mentioned above, health can be a contributing factor to a fall, but it’s by no means the only contributor, and knowing the variety of factors behind falls can make it easier for you to avoid them. With that in mind, here’s a list of common issues that can lead to falls in the elderly.

Medical Condition
While it’s not the only contributor to falls, your medical condition is obviously a potential factor. For that reason, any time you or someone in your care falls, you should take a moment to think: What was their mental state? Did they recently go on a new prescription medication? An over-the-counter medication that causes drowsiness or dizziness as a side effect may also be to blame.

In addition, older adults may suffer from one or more chronic medical conditions. While medications may mask these conditions, they can still contribute to the risk of falling even when controlled. If you or your loved one suffers from any medical condition, ask your doctor if their problem could increase the risk of a fall.

With the proper fall prevention strategies, any physical limitation can be eliminated as a falling risk.

Physical limitations can also lead to falls. There is a difference, however, between a physical limitation and a decline in a person’s physical condition. An older adult may, for example, have suffered the loss of a limb from an accident earlier in life, but while this physical limitation could increase the risk of a fall, it would not make the rest of the body any less healthy. Similarly, vision problems may require specific fall avoidance strategies while having no real bearing on a person’s overall well-being. With the proper fall prevention strategies, any physical limitation can be eliminated as a falling risk.

Environmental Factors
Your home environment may create falling hazards. A cluttered home, or one that otherwise puts obstacles in your way, can cause a fall even if your health and physical condition don’t predispose you to one. In addition, temporary variations in the home environment can create problems even if the home is normally without risks. Inclement weather, for example, may play a role: if a rainstorm causes the roof to leak water onto a kitchen floor, it’s likely an elderly adult would slip on that floor eventually. (For that reason, It’s usually best to reassess fall prevention techniques after any large scale weather event.)

Other environmental factors can come into play as well. Too much sunlight, for example, may cause an older adult to become lightheaded or woozy, and lead them to trip over a misplaced item in the house or even a door curb. Fall prevention is a holistic discipline: many factors can create a high-risk fall environment, and reducing the risks requires an ongoing commitment.

Lighting
Many falls in the senior community occur because of vision problems or limitations, but some of these risks can be reduced by using adequate lighting and making sure that lighting is working properly. Good lighting can help even those without diagnosed vision problems, and the reverse is also true: even if you have excellent vision, poor lighting can put you at risk for a fall by obscuring obstacles or making even clutter-free areas more difficult to navigate.

Too much sunlight may cause an older adult to become light-headed or woozy,

Lighting that is too bright can create its own problems. Sunlight is often the culprit in this situation, but so can lamps that create a glare. A room that is too bright can prevent you from properly assessing hazards in the room, and bright lights may also trigger lightheadedness that leads to a loss of balance.

Attire and Shoes
Beyond these environmental factors, a older person may carry a falling hazard around with them in the form of clothing. Tight clothing can heat up too fast or restrict blood flow, causing an older adult to lose short term mental capacity or motor skills. Extremely loose clothing can put you at risk as well: it can get caught on doors, windows or furniture, causing a fall.

Shoes bring their own set of issues. In general, seniors at a high risk of falls should avoid loose fitting shoes and shoes with slippery soles. If you have foot problems, shoes that fail to address them may cause trouble as well. For example, normal shoes can increase the pain and discomfort of those with fallen arches, and this pain may increase the risk of a fall.

In general, people who are at a high risk of falling should avoid shoes with soles that are too slick, high heels, flip flops and stockings.

Physical and Emotional Well Being

With these risks in mind, you should begin putting together a strategy for avoiding falls. Here, the first line of defense is taking stock of—and taking steps to improve—your or your loved one’s physical and emotional state. Here are some of the most important physical and psychological issues you should consider.

Medical Condition
Once again, many falls have nothing to do with a person’s underlying medical condition. That said, however, your physical well-being is essential to an independent life, and physical fitness is the key to preventing falls. This includes a holistic program that includes nutrition, regimented exercise, and a general openness to physical activity throughout the day. You should also have your physical well-being checked far more often than younger adults, and you should get into the habit of listening to your body and consulting with your doctor about any unexpected symptom.

Outside of the doctor’s office, some of the most effective deterrents to falls are simply healthy daily habits. For instance, drinking a healthy amount of water each day can help you avoid lightheadedness or fainting. Good nutrition is also essential, as is frequent physical activity. As you get older, healthy habits do more than just help you avoid disease: they can help you prolong your ability to live independently.

One particular set of conditions to be aware of and act on are disorders of the ear. Since the ears are an essential component of balance, you should get your ears checked regularly, and should make an extra effort to do so if you are experiencing any form of imbalance, nausea, or dizziness during your normal day to day routine.

Other conditions that may need to be checked out include numbness in the legs, shortness of breath, and joint pain. Each of these conditions may be addressed through a physical regimen.

Medications
In general, medications have a more extreme effect on elder adults than they do on younger people, and sedatives and antidepressants routinely increase the risk of a fall in an older adult. Take special heed of all side effects and symptoms, even when taking an over-the-counter medication. If you find you experience side effects that impact your mobility, work with your doctor to wean yourself off them, and do the same with any medications that may reduce your ability to locate hazards or control your body.

Physical Immobility & Injuries
Elder adults who have suffered injuries are at special risk for falls in the home. This is doubly true for people who have a previous history of falls. As you look to lower your fall risk, be aware of the following factors—and think about ways of reducing their impact.

• Lower body weakness – If the core, back, hips or legs are weak or in pain, it will have an effect on a person’s balance. Symptoms of lower body weakness include a short or impaired gait, an inability to walk for extended periods of time, pain in the lower body when performing normal activities and imbalance with no provocation.
• Foot pain – Pain in the feet can come from any number of causes. Foot injuries that are not allowed to properly heal may affect your balance in numerous ways. If your footwear is in any way uncomfortable, consider changing it as a priority within a fall prevention plan.
• Vision disorders – Any eye injury or visual impairment can increase a person’s risk of falling. People with impaired vision may misinterpret a hazard or fail to see it altogether.
• Ear disorders – The ears are essential to maintaining proper balance, and proper balance is essential to reducing the risk of falling. Elder adults should have their hearing checked as often as their eyes.
• Loss of limbs – The loss of an extremity that does not require seated transportation may increase the risk of a fall. In most cases, too, walking will require the use of an implement. The fall prevention program for such a person may include fall-protective netting, window fall prevention, lanyard fall protection, and other fall prevention tools.

Physical Exams/Annual Check Up
Again, health can be a significant factor in avoiding falls, and so it’s essential to be aware of—and seek to address—any health-related falling risks. This means that physical checkups are an essential part of any fall-reduction attempt. Checkups will usually begin with a general assessment from a family doctor and progress to specialists who will address specific issues. If possible, make sure your doctors include the following checks:

• Your gait – The way you walk says a lot about your general health, both mental and physical. This will usually be one of the first things that your doctor tests.
• Balance – Your balance is another holistic measure that will allow your doctor to drill down into more specific issues if a problem is found.
• Mobility – Your general ability to move affects your ability to react quickly to an unexpected event that may cause a fall. You also gain the ability to avoid hazards that may cause a fall if you are relatively mobile.
• Physical fitness – This is defined as the ability to easily perform day-to-day tasks. If you cannot, then you are more likely to experience a fall in the home.
• Heart rate – The heart rate affects many other aspects of the body, including brain function, motor skills, and vision.
• Blood pressure – High blood pressure may be indicative of stress, which increases the risk of a fall.
• Muscle strength – Stronger people can resist imbalance and step over hazards. People with stronger muscles will also be able to walk more effectively and balance themselves to avoid falls.
• Nerve health & reflexes – Reflexes are very important, because many falls are caused from unexpected events or hazards.
• Diet – The way that you eat speaks to your general health and may affect your heart rate, balance and vision.
• Pain – If there is any pain in your body, then your body may be trying to tell you something – something that will help you avoid a fall.
• Arthritis – Joint pain makes it harder to avoid falls. Symptoms of arthritis must be controlled as a part of a fall protection strategy.
• Fear of falling – As mentioned above, people who are more fearful of falling are actually more likely to fall. Your doctor should assess this psychological condition if it is present and work to remove it.
• Brain function – The ability to think fast speaks to your reflexes and muscular reactions. The better these are, the more you will be able to resist a fall.

Actively Reducing the Chances of a Fall

There are many fall protection systems marketed through private companies and public websites. Many of these programs use similar strategies, and as you work to reduce the risk of falling, you should take advantage of these common approaches.

1. Address any medical conditions – As stated above, you should seek frequent medical checkups. The health of the individual is the most important aspect of fall protection.
2. Modify the environment – To reduce the risk of a fall, reduce the number of hazards in your home. And as you do so, keep in mind your or your loved one’s physical limitations you can to eliminate risks that you may face in particular. Some common modifications include front-door showers, putting carpet on floors, widening door frames, reducing door curb height and installing various fall protection systems.
3. Improve the older adult’s physical fitness – Beginning a daily exercise regimen greatly reduces the risk of a fall. The benefits include stronger muscles, bones, and connective tissue, an increased awareness of the environment, more energy for greater balance and a stronger gait, and a higher resistance to unexpected events. Special exercises may be employed to bolster weaker areas and improve holistic physical fitness.
4. Get the right clothes and shoes – Any and all loose clothing that could catch on a door frame, nail, or furniture should be removed from the home. Choose shoes that fit and follow the limitations mentioned above (no slick soles, no loose material, etc.).
5. Improve your home’s lighting – Your home should be neither too bright nor too dark. A dark home hides hazards, and a home that is too bright can be just as dangerous. In general, if there is so much light that it causes the resident of the home a problem, then it should be reduced. This includes rooms in the home that may let in too much sunlight during peak hours.
6. Incorporate the appropriate assist devices – Older adults who have physical limitations may need to use a walker or cane to help them get around, and you should adjust your fall prevention plan accordingly. In addition, many fall prevention programs include installing grab bars throughout the home.
7. Get proper nutrition – Eating properly helps an elder adult engage more thoroughly with the surrounding environment. A good diet improves the nervous system, gives energy to the body’s muscle systems, and encourages heightened brain function. And getting adequate liquids can produce similar benefits.

What to Do If a Fall Happens

Prevention is the best way to avoid the injuries and other problems related to falls. But accidents happen despite the best laid plans. If you witness a fall, you experience a fall or you are called into a situation involving a fall, follow the steps below.

If You Fall
Remain calm. Assess your physical well being. Can you get up? Do you feel pain if you try? Stay down as long as it takes to assess your condition, and do not make any overly strenuous or sudden movements.

If you think you can get up, follow these steps.

1. Lie down on your side. Bend your top leg and lift your upper body into position resting on your elbow.
2. Pull your body towards a sturdy stationary object. Drag yourself up into a kneeling position while using your hands to pull yourself up.
3. Put your strong leg in front of your body while you are holding the stationary object.
4. Stand up.
5. If you are near a chair, turn, sit down, and call for medical assistance.

If you cannot get up, follow the steps below.

1. If you feel as though you will be heard, call out for medical assistance.
2. If you have a fall prevention lanyard, take it out to serve as identification. Use your cell phone to call for assistance if you have it on hand and you can reach it without straining yourself.
3. If you do not have your cell phone or emergency call device on hand, slide yourself to the nearest phone or bench.
4. Make as much noise as possible to draw attention to your situation. Use your walking implement if you need to.
5. Get into a comfortable, safe position and wait for help. Make sure to protect your joints.

If Your Loved One Falls

If the person who has fallen cannot get up, call for medical assistance first, if necessary, and then administer first aid without moving them. If you do not know first aid, make sure the person is as comfortable as possible until professional medical assistance arrives. Pay special attention to the joints.

If the person who has fallen can get up, help that person by bringing a chair. Help the person achieve the positioning mentioned above in the section entitled, “If You Fall.”

Getting Help

Whether you are the victim of a fall or the witness, never underestimate the gravity of a fall in an older adult. Do not assume that just because no side effects are readily apparent that there are none.

If any of the following things seem to follow as a result of a fall, call a doctor immediately: lingering pain, dizziness, nausea, weakness, loss of consciousness, any visually apparent injury, drowsiness, headache, or vision problems. These symptoms may appear in the days after a fall or immediately afterward. A doctor should be called in either situation.

How to Contact People in the Event of a Fall

It is always best for an elder adult to have a cell phone in an easily accessible place. Lanyards are great ways to ensure that even if a person falls, the communication device will be within reach of the hands.

Even better than a cell phone is an emergency fall device. These devices only have one function—summoning professional medical help immediately. The also have a much longer battery life and are much more accessible to many older adults. Some of these devices are connected to insurance programs that may help pay for the equipment.

How Loved Ones Can Help Prevent a Fall

The loved ones of an older adult are the most important resource when it comes to fall prevention. Loved ones can research and install the home improvement features that can help prevent a fall, and they can check on an older adult frequently to assess the home for hazards and provide rides to the doctor for checkups.

Most importantly, loved ones can provide emotional support. Older adults must be informed that falling is not a normal part of aging, and that they can take steps to assure their continued independence. Relatives can also help with common fall avoidance strategies, including helping the older adult stay more physically active, and relatives can inform other family members about fall prevention techniques.

Falls among the elderly are a serious problem, and a bad fall can can have a huge impact on an otherwise healthy and independent life. The good news, however, is that falls can be prevented. By doing a little planning and by taking concrete steps, this threat can be reduced or eliminated, giving you and your loved ones many years of independent living.

Fall Prevention: Balance and Strength Exercises for Older Adults

Falls can have very serious consequences as we age. Each year, more than 25
percent of adults 65 or older have a fall, and 3 million are treated in
emergency departments for fall injuries, according to the Centers for
Disease Control and Prevention.

Fall Risks

The risk of falling in older adults is usually related to combination of
factors, including:

• Balance and/or walking problems. Balance can be affected by vision
  changes, vestibular problems and altered sensation in the feet.
• The use of multiple medications. Studies indicate that when individuals
  take five or more medicines, the risk of falls increases.
• Home hazards (including dim lighting and trip hazards)
• Positional low blood pressure (such as orthostatic hypotension, when
  blood pressure drops upon standing.
• Feet and footwear issues

Falls often occur in the bathroom when sitting or standing from the toilet
or shower, or at night in a dark bedroom when getting up quickly and
tripping on the way to the bathroom.

Exercises to Prevent Falls

While it’s not possible to completely

prevent a fall, exercises that focus on balance and strength training can

reduce the risk of falling. “We treat elderly adults for injuries sustained from falls, and other
patients who feel unsteady while walking or standing and are fearful of
falling,” says Lora Stutzman, a physical therapist with the

Johns Hopkins Rehabilitation Network. “These exercises can help improve balance and build strength to help
prevent future falls.”

For older adults, activities such as squatting, standing up from a chair
and walking may be difficult or cause them to feel unsteady, which
increases their risk of falling. The following exercises are intended for
those who have a low risk of fall and are able to stand on their own
without support from others. Always talk to your doctor or physical
therapist first before starting new exercises, especially if you have weak
balance.

Stutzman demonstrates two exercises below.

Sit-to-Stand Exercise

The sit-to-stand exercise builds leg strength and improves body mechanics
and balance, which are all important in reducing falls.

1. Start by sitting on a sturdy chair of standard height, and make sure
that it won’t slide or roll. You should be able to sit comfortably with
your feet flat on the ground. Have a sturdy support surface in front of
you, such as a countertop, so that you can reach to it for support if you
start to feel unsteady when standing. Scoot forward so your buttocks is
positioned at the front of the seat.

2. Lean your chest forward over your toes, shifting your body weight
forward. Squeeze your gluteal muscles and slowly rise to a stable standing
position.

3. Slowly sit back down to the starting position and repeat 10 times.

4. If necessary, place your hands on the arms or seat of the chair and push
through your hands to help stand and sit. The goal is to not use your hands
at all.

Perform 10 repetitions, twice a day. For an advanced version, hold hand
weights to add resistance.

If you have pain in your knees, back or hips, discontinue and talk to your
doctor or physical therapist.

Balance Exercise

This series of exercises helps if your balance is unsteady. Make sure you
have someone with you in case you lose balance.

To begin, stand in a corner or have a kitchen counter in front of you to
reach out to in case you start losing balance.

1. Feet apart: Stand with feet about shoulder-width apart,
eyes open, and hold steady for 10 seconds, working your way up to 30
seconds.

If you find yourself swaying or reaching for the wall or counter
frequently, just keep working on this exercise until you can do it with
minimal swaying or support. Once you can hold this position firmly for 30
seconds, move on to the next exercise.

2. Feet together: Stand with feet together, eyes open, and
hold steady 10 seconds, working your way up to 30 seconds.

Once you can do this exercise for 30 seconds with minimal swaying or
support, move on to the next one.

3. One foot: Stand on one foot, eyes
open, and hold steady 10 seconds, working up to 30 seconds. Switch to the
other foot.

4. Eyes closed: If you can perform the first three
exercises safely and with little support, try to do each one with your eyes
closed. Hold for 10 seconds, working up to 30 seconds.

The goal for each exercise is to hold the position for 10 seconds and
progress to 30 seconds, five repetitions (including five per leg on the
one-foot exercise), two times a day.

Additional Steps to Prevent Falls

Remember, it’s important to talk to your doctor or physical therapist about
fall prevention.

• Discuss medications and changes in your exercise routine.
• Tell your doctor if you fall.
• Ask a friend or family member to help check your home for trip hazards.

“Keep in mind,” adds Stutzman, “it is always best to have company at home
with you while exercising for safety and supervision and in case you need
help.”

Preventing Falls in Older Adults

COVID-19 and Preventing Falls: Staying Safe While Staying Home

One in three older New Yorkers experience falls, and most of these falls happen at home. Prepare to safely stay inside during the COVID-19 response with these fall prevention tips:

• Home Safety: Find and fix trip and fall hazards in your home. If you are working from home, be careful of computer and electrical wires. Coil the wires next to the wall and tape them down if you can.

• Physical Activity: Be active! Physical activity is a great way to prevent falls and there are many exercises that can be done at home.
• Care for Your Feet: Wear the proper footwear, even at home. Learn more about how to keep your feet healthy.
• Medicine Safety: Continue your medicine routine. It is important to manage your medications and take all your prescriptions. Pharmacies remain open and many are offering free delivery. Call your pharmacist to discuss refills and possible delivery options.

Every year, one in three Americans aged 65 and older experiences a fall. In New York City, falls are the leading cause of injury-related death and hospitalization for older adults. In addition to serious injuries and deaths, falls can affect the quality of life for older adults, sometimes making it harder for them to live independently. Although falls are common, they do not need to be a normal part of aging. Falls are preventable and everyone can help older adults avoid them.

Preventing falls for seniors is a priority for a number of city-wide initiatives including OneNYC, Take Care New York 2020 and Age-friendly NYC. Learn more about the Health of Older Adults in New York City (PDF).

Tips and Strategies

Falls can happen for many reasons. The main factors that can lead to falls include:

• Muscle weakness
• Trouble with mobility or balance
• Side effects of medications
• Fear of falling.

You can prevent falls by:

Learn how you can protect yourself and gain confidenceIn Case of a Fall.

Caregivers and Providers

If you are taking care of an older adult, check out the Department of Heath’s tips and resources for new and experienced caregivers.

New York City Falls Prevention Coalition

The New York City Falls Prevention Coalition brings together partners from across different sectors to leverage information and resources to reduce the incidence and burden of falls among vulnerable populations. For more information, contact the Falls Prevention Coalition at [email protected].

Additional Resources

More Information

To get free falls prevention documents by mail, call 311.

Falls – Prevention – NHS

There are ways you can reduce your risk of having a fall, including making simple changes to your home and doing exercises to improve your strength and balance.

If you have fallen in the past, making changes to reduce your chances of having a fall can also help you overcome any fear of falling.

Some older people may be reluctant to seek help and advice from a GP and other support services about preventing falls because they believe their concerns will not be taken seriously.

But all healthcare professionals take falls in older people very seriously because of the significant impact they can have on a person’s health.

Discuss any falls you have had with a GP and say if it’s had any impact on your health and wellbeing. 

The GP can carry out some simple balance tests to check whether you’re at an increased risk of falling in the future. They can also refer you to useful services in your local area.

Avoiding falls at home

Tips for preventing falls in the home include:

• immediately mopping up spillages
• removing clutter, trailing wires and frayed carpet
• using non-slip mats and rugs
• making sure all rooms, passages and staircases are well lit
• organising your home so that climbing, stretching and bending are kept to a minimum, and to avoid bumping into things
• getting help to do things you’re unable to do safely on your own
• not walking on slippery floors in socks or tights
• not wearing loose-fitting, trailing clothes that might trip you up
• wearing well-fitting shoes that are in good condition and support the ankle
• taking care of your feet by trimming your toenails regularly and seeing a GP or podiatrist (foot health professional) about any foot problems

Strength and balance training

Doing regular strength exercises and balance exercises can improve your strength and balance, and reduce your risk of having a fall.

This can take the form of simple activities such as walking and dancing, or specialist training programmes. 

Many community centres and local gyms offer specialist training programmes for older people.

Exercises that can be carried out at home are also available. Ask a GP about training programmes in your area.

It’s important that a strength and balance training programme is tailored to the individual and monitored by an appropriately trained professional.

There’s also evidence that taking part in regular tai chi sessions can reduce the risk of falls. Tai chi is a Chinese martial art that places particular emphasis on movement, balance and co-ordination.

Unlike other martial arts, tai chi does not involve physical contact or rapid physical movements, making it an ideal activity for older people.

Read more about physical activity guidelines for older adults

Sight tests

Look after your eyes and make an appointment to have a sight test if you’re concerned that vision loss (even when wearing glasses) is increasing your risk of having a fall.

Not all vision problems can be cured, but some problems can be treated with surgery – for example, cataracts can be removed using cataract surgery.

Alcohol

Drinking alcohol can lead to loss of co-ordination and exaggerate the effects of some medicines.

This can significantly increase the risk of a fall, particularly in older people.

Avoiding alcohol or reducing the amount you drink can reduce your risk of having a fall.

Excessive drinking can also contribute to the development of osteoporosis.

Page last reviewed: 25 June 2021
Next review due: 25 June 2024

Why Older Adults Fall & What to Do

To be honest, people don’t usually ask me this.

Instead, they want to know things like “How do I keep my mother from falling?” or “What should I do? My grandfather’s been falling. ”

After all, falls are a scary thing. Most people know that falls are dangerous for older adults.

The Center for Disease Control (CDC) reports that one in five falls causes a serious injury such as a broken bone or head injury. Fear of falling can also seriously affect an aging adult’s quality of life and sadly, can keep a person from being active and thriving.

So, many seniors and family caregivers are interested in fall prevention because the risks are so great. And the good news is that although it’s not possible to prevent all falls, it almost always IS possible to take actions that will reduce the chance of a bad fall.

If you want to learn more, you’re in the right place.

In this post, I’ll cover:

• How understanding why aging adults fall can help you keep an older parent — or yourself — safer,
• Why personalized fall prevention plans work better than relying on general fall prevention tips,
• The four-step process I use to help older adults prevent falls,
• A practical example showing you how to use these steps to avoid falls yourself.

First, understand why older people fall

There are many reasons that aging adults fall. Most older people will be falling due to their own unique combination of reasons.

So how, exactly, should YOU go about reducing fall risk?

Now, you can — and should — try to implement the general tips that are often listed in most fall prevention resources: exercise, medication review with the doctor, vision checks, and home safety reviews.

But if you really want to help an older loved one avoid falls, I recommend you learn to better understand why he or she, in particular, might fall.

Why? Because when you understanding the specific reasons an older person may be falling, you’ll then be able to:

• Identify which fall prevention strategies are most likely to help the person you worry about,
• Recognize risky situations, and take steps to avoid them,
• Know which medical conditions — and which medications — to ask your doctors to look into,
• Understand what may have caused a specific fall, which can help you avoid future falls.

In other words, learning why older people fall means that you’ll be able to figure out why YOUR older relative is likely to fall — and take steps to help them.

Why personalized fall prevention works better than general fall prevention

Once you understand the particular factors contributing to your older loved one’s risk, it will be easier to focus on the fall prevention strategies that are most relevant to your situation. In other words, you’ll be able to personalize your approach to fall prevention.

Personalizing fall prevention is critical. You don’t want your mom to start by spending a lot of time on tai chi, if her current major risk for falls might be that her blood pressure medications are too strong, or her eyesight is terrible.

Also, don’t assume that most doctors will identify and manage the most important risk factors for falls. In my experience, busy doctors often miss opportunities to reduce fall risk, unless a family is proactive in asking for the right kind of help.

Now that we’ve covered how understanding falls can help you, let’s talk about falls. First, I’ll explain why any fall happens. Then I’ll share my framework for understanding why a particular older person might fall.

Why a fall happens

Why does a fall happen? Fundamentally, no matter who you are and what age you are, here’s why:

Challenge to balance or strength > Ability to stay upright”

In other words, we fall when we experience some kind of event that challenges our balance or strength. If this event overwhelms our ability to remain upright, down we go.

When we’re young and healthy, we tend to have lots of ability to stay upright. So if we stumble, we can often catch ourselves and recover before we fall. But of course, a big enough knock off-balance will send even a 20-year-old sprawling. And if that 20-year-old happens to be tipsy, it will take even less of a trigger to provoke a fall.

Illness or weakness is another situation that will reduce anyone’s ability to stay upright. (This is why people of all ages are prone to fall in the hospital.) But of course, older adults often have many other things going on which affect their ability to stay on their feet.

4 Steps to Reduce Fall Risk

Falls in older people are almost always “multifactorial.” This means there are usually several factors that are contributing to a fall, or to a person’s fall risk.

It can be hard to try to address every single factor. And some, such as slower reflexes, may be impossible to reverse.

Still, it’s often useful to go through them and try to spot a few that are either easy to fix, or potentially offer a big reduction in fall risk.

As a geriatrician, here’s what I do:

• Create a list of factors contributing to an individual older person’s fall risk.

• Identify risk factors and triggers related to recent or recurrent falls.

• Identify the factors that are easiest to modify or change. This is partly about the factor itself, and partly about what’s feasible for my patient to try to change. (Stairs can be a risk, but changing houses can be tricky.)

• Implement practical strategies to address modifiable fall risk factors. 

3 types of fall risk factors you should consider

I also find it helpful to think of the factors as belonging to one of three categories:

• Health-based risks. This includes things like balance problems, weakness, chronic illnesses, vision problems, and medication side-effects. They are specific to an individual person.

• Environmental risks. These are things like home hazards (e.g. loose throw rugs), outside hazards (e.g. icy sidewalks), or risky footwear (e.g. high heels). This category can also include improper use of a walker, cane, or other assistive device.

• Triggers: These are the sudden or occasional events that cause a challenge to balance or strength.  They can be things like a strong dog pulling on a leash, or even health-related events like a moment of low blood sugar (hypoglycemia) in a person with diabetes.

Now, you will probably find it hard to make a list of all these factors on your own. The health-based factors, in particular, tend to be closely related to medical problems. So they can be hard to properly sort out unless you’ve learned a lot about medicine.

Still, I encourage older adults and family caregivers to learn to think about fall risk factors, since this can help people get better at asking their doctors the right questions.

Below are slides from a talk I’ve given, on how older adults can reduce their fall risk:

Example: Why is Mr. Jones falling?

Let’s consider an example together, to illustrate how you can put this understanding to work.

Mr. Jones is 82 years old. He lives at home with his wife, and takes a daily walk in his neighborhood. He has had diabetes for a long time, and has chronic numbness in his feet.  He is on medication for diabetes, high blood pressure, and also uses Tylenol PM.

His daughter Wendy subscribes to a newsletter about better health for aging parents, and she recently read the CDC’s fact sheet on how important fall prevention is. She would like to keep her father from falling.

What should Wendy do? As I mentioned earlier, the usual recommendations to lower fall risk are a good place to start. So Wendy could encourage her father to remain physically active, and she might want to take a closer look at the house to remove common trip hazards.

She might also want to help him get evaluated for vision problems and for low leg strength, since these are common fall risk factors among people Mr. Jones’ age. Furthermore, diabetes can cause or worsen vision problems.

But if Wendy wants to personalize the fall prevention plan, she should also consider asking the doctor to help make a list of Mr. Jones’ health-based risk factors.

In Mr. Jones’ case, some additional factors that jump out at me are:

• Chronic numbness in feet. This is a common problem in people who have had diabetes for a long time, and it can definitely affect how easily people stay on their feet.
  • It’s good to be aware of this risk, however, this problem usually can’t be cured or reversed.

• Diabetes. Some people with diabetes are prone to episodes of low blood sugar (hypoglycemia), especially if they take insulin or other drugs to actively lower blood sugar.
  • Wendy could ask her father if he ever has low blood sugar episodes, which could trigger a fall. If he does, she should make sure this is addressed with the doctor.
  • It is often appropriate to relax blood sugar control as people become older and frailer. This is because as people age, tight control brings fewer benefits but more risks.

• Blood pressure medication. This could increase fall risk, especially if Mr. Jones’ blood pressure is often below 120/80.

• Tylenol PM. Any over-the-counter medication labeled “PM” contains a sedative, usually in the form of an antihistamine such as diphenhydramine (brand name Benadryl). Older adults are often sensitive to these drugs, which can worsen balance or even thinking.
  • Wendy should help her father review his medications. She should focus on spotting sedatives or any other medications with strong “anticholinergic” effects, such as a medication for overactive bladder. (For a link to a good list of anticholinergic drugs to avoid, see this post.) All sedating or anticholinergic drugs increase fall risk, but doctors may forget to avoid or minimize them unless a family specifically requests this.

You may have noticed that in this example, I’ve particularly focused on medications.

That’s for three key reasons:

• Medications are among the most common causes of increased fall risk in older people.

• Medications are often a fixable risk factor, when it comes to falls in older adults.

• Medication-based risks are often missed by busy regular doctors. Family caregivers can make a big difference by being proactive in this area.

If you’re concerned that you or your older relative might be on medications that are increasing your fall risk, see this article: 10 Types of Medications to Review if You’re Concerned About Falling.

Take the next step: create a personalized fall prevention plan

Remember, older adults usually fall because a) multiple risk factors make them vulnerable to falling, and b) a stumble or moment of weakness triggers the actual fall.

Most fall risk factors are health-based, and are related to chronic medical conditions or medications. And then some fall risk factors are environmental, and involve the home or outside environment.

You can definitely reduce fall risk by encouraging strength and balance exercises, and by optimizing the home environment.

But you’ll be most effective in preventing falls if you can get your doctors to help you understand your loved one’s personal fall risk factors.

This way, you’ll be able to develop a more personalized fall prevention plan…one that targets the risks and vulnerabilities most relevant to YOUR situation.

Questions about personalizing fall prevention? Please let me know in the comments below!

Or better yet, take our online Personalizing Fall Prevention Mini-Course, and I’ll help you identify the fall risk factors most likely to matter in YOUR situation.

Click here to learn more about the online Fall Prevention Mini-Course.

Safety for seniors: Preventing falls in the bathroom :: Belvedere Health Services

Bathrooms can be a dangerous place for seniors. The floors are slick, the surfaces are wet, the space is small and everything is hard.

If you fall in a bathroom, there is a good chance that in addition to the impact of hitting the floor, you will hit some part of your body – head, knee, shoulder – on a cabinet or fixture.

Recent studies have shown that for people aged 65 and older, falls account for approximately 60 percent of all injury-related emergency department visits and over 50 percent of injury-related deaths annually. And up to 80 percent of falls in the home occur in the bathroom. These fall-related injuries can range from minor scrapes and bruises to broken bones, head injury and spinal cord injury.

When are loved ones at risk?

Most falls occur while seniors are transferring in and out of the tub or shower or while using the toilet.

Seniors who are experiencing balance or mobility issues also fall when they are using sink tops, shower bars, hampers or other unstable objects to support themselves when in the bathroom.

Slick tile floors and small bathroom rugs can be a tripping hazard and cause a fall even if a senior is going into the bathroom to wash their hands or brush their teeth.

Adding safety features to a bathroom

Installing safety features is a relatively easy and inexpensive way to help prevent your senior loved one from falling in the bathroom.

• Install grab bars in the shower, beside the tub and at the toilet.
• Falls often occur when seniors are getting in and out of the tub or shower or standing up after using the toilet. Place a non-slip mat or decals on the floor of the shower or bathtub and a non-slip rug on the floor outside the tub or shower. Non-slip mats – rather than fluffy rugs – are also the way to go in front of the toilet and the sink.
• Use a shower chair so your senior can sit while showering and prevent slips and falls. Make sure the chair has a non-slip seat and rubber tips on the feet so it won’t slide in the shower or tub.
• For seniors who need assistance stepping out of the tub, a bath or transfer bench can help. The bath bench extends over the side of the bathtub with two legs resting on the floor. Seniors can sit on the bench, swing their legs over the side of the tub, and more safely stand.
• Install a raised toilet seat, which raises the seat height by 3 to 4 inches to reduce the amount of effort needed to sit and stand when using the toilet.
• Place shelves at eye level in the bathroom for toiletries, so seniors don’t have to reach up into a cabinet or bend down to look inside a vanity to get shampoo, toilet paper, air freshener, etc.
• Regular Cleaning. Soap scum and build up from condensation can leave surfaces slippery. Scrub tubs, showers, grab bars and mats regularly to prevent a slick residue build-up.
• Use a nightlight or motion-sensor lighting to ensure seniors have adequate light for nighttime visits to the bathroom. Use a nightlight in any hallway along the path to the bathroom from the bedroom or living areas.

Home health care can reduce the risk of bathroom falls by helping you find ways to improve the safety features of the home, monitoring seniors while they use the bathroom and assisting with personal care.

If you have questions about fall hazards and senior safety, contact Belvedere Home Care to learn more about our flexible home health care programs: (518) 694-9400.

Preventing falls for seniors | Bayhealth

Every 11 seconds, a senior visits an emergency department because of a fall. More than one-third of adults age 65 and older fall each year. Falls have a big impact on seniors, both physically and emotionally. Many people will let a fear of falling impact their daily life. They become less active and more reclusive. While the statistics are pretty scary, the truth is, falls are preventable. Diana Curtis, RN, MSN, trauma registrar at Bayhealth and member of the Delaware Falls Prevention Team, offers simple steps everyone can take inside and outside their home to reduce fall risk.

STAIRS:

Make sure stairs are well lit and that a handrail is available the entire length of the staircase. Consider adding contrast to the stairs by placing strips of color at the end of each step. Remove clutter like shoes, clothes, magazines, etc.

FLOORS:

Like stairs, floors need to be free of clutter. This could include things like piles of books and magazines or cords and electronics. Area and throw rugs can also be problematic. If the rugs must stay, secure them with nonskid tape. Choose slip-resistant rugs for bathrooms and kitchens. If you have a pet, place food and water bowls in an area where they won’t be a tripping hazard.

FURNITURE:

Arrange furniture so you have a clear walking path around it. In the bedroom, ensure your bed is the proper height — it should be easy to get in and out of. You may also want to install bed rails that offer stabilization while getting in and out of bed.

OUTDOORS:

Outdoor lighting can be helpful, particularly on paths in and out of the house. It’s also important to know weather conditions, and be ready for wet or slippery areas outside.

OTHER MEASURES:

Have your medications checked at least once a year by a pharmacist or medical provider. You should also have your eyes and ears checked once per year. There are also exercise and balance programs available. “Matter of Balance” classes are offered throughout the state by Volunteer Delaware 50+.

If you’re concerned about falling or want more information about assistive devices, talk to your primary care physician.

If you are in need of a primary care physician, call 1-866-Bay-Docs to learn about providers in your area. For more information about resources available through Bayhealth, go to Bayhealth’s Classes and Events page.

90,000 Prevention of falls and injuries in the elderly

Winter is a time of increased risk, associated with the traumatic effect of cold on the body and mechanical injuries. According to statistics, “winter” injuries give up to

15% of morbidity with temporary disability and 20% is the cause of disability. Due to the condition of the carriageway, road traffic injuries in winter are up to 3% more frequent than the usual 1%.In addition to becoming more frequent, they also become more severe – often fatal – and injuries pose a serious threat to the health and lives of people of all ages. Every year millions of people around the world are injured, disabled, and deprived of their lives for various reasons.

Falls in the elderly are the sixth leading cause of death. A third of all elderly people fall at least two to three times a year. Moreover, every fifth result of an unsuccessful “landing” is fractures of the femur and humerus, pelvis, vertebrae, soft tissue damage.The most dangerous for the elderly are injuries, fractures complicated by hypothermia, which often happens if a person, having fallen, lay without help for a long time.

The main cause of falls and injuries in the elderly may be cardiovascular and neurological diseases typical of old age. These diseases are often accompanied by dizziness. Deterioration of vision, joint pain also contribute to injury. Particular care is needed for stroke survivors with movement disorders and other neurological disorders.

A decrease in physical activity also has a certain effect. Those who have been on bed rest for a long time have a much higher risk of falling during the recovery period. Moreover, the feeling of anxiety arising after such a fall, the fear of a repetition of what happened, force a person to move even less, which means that the risk of falling and getting injured increases.

Some drugs used in geriatric practice can, unfortunately, provoke such accidents.When starting to take medications, be doubly careful, be sure to consider their side effects.

An elderly person can be injured in a variety of circumstances: It can happen at any time on the street or on a staircase, in a bedroom when getting out of bed or on a slippery bathroom floor. It is estimated that a third of older people fall approximately two to three times during the year. Every fifth fall ends with a fracture, soft tissue injury or hematoma.

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

Factors such as ice in winter, uneven road surface, poor illumination, lack of outside help from people who need it, etc. are also of great importance.

50% of falls occur at home, especially in the bathroom and bedroom. Many older people are injured without witnesses, which makes it impossible for them to get help quickly.

Recommendations for the prevention of injuries to older people.

• 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, joint diseases, osteoporosis.
• Periodic eye and hearing tests are required to order stronger glasses or hearing aids in time.
• Performing home balance and muscle exercises as directed by a physician and daily walking.
• Maintaining the optimum temperature in the living room, since significant temperature drops impair the blood supply to the brain, which leads to impaired coordination of movements.
• All dangerous places where the elderly may fall: stairs, corridors, bedroom, bathroom – must be well lit.Install the electrical switch in the bedroom so that you can reach it without getting out of bed.
• It is advisable to cover the polished furniture handles with fabric covers so that the hand does not slip when getting up.
• Entrance hall, toilet must be equipped with special handrails. An important role is played by the furniture in the room where the elderly person lives. So, the bed should be at least 60 centimeters, the chairs should be shallow, soft, the backs of the chairs – high so that there is support for the head.When getting out of bed, you should avoid sudden movements.
• Trauma can often be obtained during washing, bathing. The bathroom should be equipped with handrails, support and a special bench that is attached to the edge of the bathtub. There must be a rubber mat on the bathroom floor.
• The telephone must be positioned so that, even after falling, a person could reach the telephone and call an ambulance or call someone close to him.
• It is important to choose the right footwear.It should be loose, but not too large, soft and with grooved soles (read about testing and certification of footwear and clothing here).
• It is advisable to wear shoes with flat or low square heels. It is better if the sole is with coarse ribbing, which does not slip.
• It is necessary to walk in icy conditions in a special way – as if sliding a little, as if on small skis. It is advisable to go as slowly as possible. Gliding on the ice is not specifically worth it – this increases the icing of the sole.Remember, the faster the step, the greater the risk of falling.
• Elderly people, most susceptible to injury, are recommended to attach special anti-icing pads to the soles of their usual shoes.
• 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, in order to prevent falls during walks, it is advisable to use a support cane with an anti-skid device, to 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 advisable to be accompanied by acquaintances or friends, while choosing a route through crowded and lighted places.

Reducing injuries among the elderly is possible not only if the state cares about this category of the population, but also if citizens themselves are attentive to their health and safety.

If you suffer from diseases that can provoke falls in the elderly, do not postpone a visit to a cardiologist, neurologist, orthopedist.Specialist advice will help prevent trouble.

In order not to slip on the ice, you can stick an ordinary medical patch on the soles of your shoes – however, this product is not very durable, but rather reliable. Going to the store, try not to have both hands busy with bags, leave at least one free. And the most important advice in case of ice: look under your feet and if you see a dangerous area in terms of a possible fall of the elderly, it is better to go around it or, in extreme cases, ask someone to give you a hand.

And a few more recommendations. Avoid sudden movements if the doorbell rings unexpectedly or on the phone: hurrying up can hurt yourself.

Head of the clinical laboratory of occupational pathology

Republican Unitary Enterprise “Scientific and Practical Center of Hygiene”,

Ph. D. A.V. Zelenko

90,000 Osteoporosis in Elderly Patients | Dudinskaya

INTRODUCTION

Over the past centuries, life expectancy has increased significantly throughout the world, which has led to the emergence of new challenges for modern medicine.An in-depth study of aging processes is needed, the knowledge of which will improve the quality of life of elderly patients. Elderly and senile patients in need of care are assigned to the group of senile asthenia, which includes various parameters determined both by the patient himself using special geriatric scales and questionnaires (weight loss, weakness, fatigue, decreased physical activity), and the participation of a medical professional with the help of special tests assessing, in particular, the speed of movement, a decrease in hand strength [1].Various geriatric syndromes detected in the elderly are interrelated [2]. So, weight loss or sarcopenia is characterized not only by a decrease in muscle mass, but also subsequently by the development of osteoporosis. Osteoporosis is characterized by low bone mineral density (BMD) and a violation of the microarchitecture of bone tissue, which leads to increased fragility of bones and an increase in the incidence of low-traumatic fractures in elderly and senile patients. Bone is a dynamic structure, and throughout most of life (with the exception of childhood and old age), the processes of osteosynthesis and resorption of bone tissue are maintained in it.Any disturbances in the process of osteosynthesis lead to a decrease in BMD. Despite the fact that osteoporosis is considered a systemic disease according to clinical guidelines, there is also local osteoporosis, which is most often a frequent traumatic complication. Systemic osteoporosis is divided into primary (hereditary, juvenile, idiopathic, involutive) and secondary. Most of all systemic osteoporosis is primary involutive osteoporosis (about 85%), which is divided into postmenopausal (type I) and senile (type II) [3, 4].Senile osteoporosis is diagnosed mainly in people over 70 years of age.

ETIOLOGY AND PATHOGENESIS OF SENILE OSTEOPOROSIS

Senile, or senile, osteoporosis depends on various factors: the aging process itself, the presence of concomitant diseases, lifestyle, physical activity, drug therapy, hormonal status. Senile osteoporosis affects both women and men equally, which has been confirmed in many studies, for example, in the Rotterdam study [5], conducted in 2004.Senile osteoporosis is associated not only with an increase in osteoclast activity, but also with a decrease in the number and activity of osteoblasts, which slows down bone formation and leads to a decrease in total bone mass.

It is now known that chronic inflammation, which is an important mechanism for the initiation and development of aging, also affects the processes in bone tissue. Thus, a significant role in bone remodeling is played by proinflammatory cytokines such as IL-6, TNF-α, IL-1, among which IL-6 and IL-1 are powerful stimulators of the differentiation and activation of osteoclasts, which leads to active bone resorption, and TNF-α not only stimulates bone resorption, but also inhibits the formation of new bone. In addition, the inducible pathway of nitric oxide synthesis is activated through the action of IL-1 and TNF-α. This pathway of nitric oxide synthesis inhibits the production of new osteoblasts and can induce osteoblast apoptosis.

With age, certain hormonal changes occur: the level of growth hormone, sex hormones and insulin-like growth factor (IGF) changes. An increase in the level of IGF-binding protein, which reduces the bioavailability of IGF and neutralizes its functional activity, was noted in people of old and elderly age.Normally, IGF increases the number of active osteoblasts by stimulating the proliferation and differentiation of bone marrow mesenchymal cells into osteoblasts.

Vitamin D deficiency, which increases with age, makes a significant contribution to the pathogenesis of bone aging. In the absence of metabolic disturbances in the body, 1,25-dihydroxyvitamin D3, or calcitriol (the active form of vitamin D), ensures the absorption of calcium in the intestine, a decrease in the level of parathyroid hormone (through direct and indirect effects), thus leading to a decrease in bone resorption. Accordingly, even a mild vitamin D deficiency can lead to secondary hyperparathyroidism with the subsequent development of osteoporosis. A decrease in the content of vitamin D in the body in old age may be associated not only with a decrease in the consumption of food containing vitamin D, due to a decrease in appetite, socio-economic factors, changes in the patient’s taste characteristics, but also a slowdown in its formation from provitamin D3 in the skin, a violation synthesis of the active form of vitamin D (1,25-dihydroxyvitamin D3) in the kidneys, which are also involved in the aging process [6].Due to the deterioration of calcium absorption in the intestines in people over 65 and as a result – a decrease in its level in the blood serum, the production of parathyroid hormone increases through the mechanism of negative feedback, which, to normalize the level of calcium in the blood, flushes it out of the bones, activating the process of bone tissue resorption [7].

A characteristic feature of senile osteoporosis is the uniformity of bone lesions: cancellous bone in the axial skeleton, cortical bone in the extremities. As a result, in senile osteoporosis, the most characteristic fracture sites are the vertebrae (wedge-shaped painless fractures) and the femoral neck, while in postmenopausal osteoporosis cancellous bone is affected, and compression fractures of the vertebrae are observed, accompanied by severe pain [3, 7].

OSTEOPOROSIS RISK FACTORS

Diagnosing osteoporosis before complications of the disease develop, that is, before a fracture occurs, is a rather difficult task, however, knowing the risk factors of osteoporosis and fractures, it is possible to observe patients at risk and prevent further progression of the disease.Previously, the risk factors for the development of osteoporosis were identified: modified and unmodified, however, at present, in the group of all postmenopausal women and men over 50, it is recommended to assess the individual 10-year probability of a low-traumatic fracture using the FRAX algorithm (fracture risk assessment tool), which takes into account the probability lethal outcome from other causes (Table 1) [4, 8]. Despite the fact that this algorithm is recommended by WHO, it has some drawbacks, since it does not take into account such conditions that are relevant to people of old and elderly age, such as, for example, anticancer treatment, age over 90 years, the number of cigarettes smoked, the location of the fracture suffered, the presence of senile asthenia.Also, FRAX does not take into account the damage to the kidneys and the degree of decrease in their function, but, despite this, it is worth paying special attention to patients on dialysis, since this procedure significantly increases the risk of fractures. In addition, it should be noted that using the FRAX algorithm it is not possible to evaluate patients who have previously received and are receiving therapy for osteoporosis (with the exception of patients who have not received therapy for more than 2 years) [3, 4, 8, 9].

Table 1. Risk factors for osteoporosis

Notes: BMD – bone mineral density; BMI – body mass index; * – low testosterone levels in men with corresponding symptoms and early menopause in women (previously 45 years old).

FEATURES OF GERIATRIC PATIENTS

With age, structural changes and involutive processes occur in various organs and tissues, the reparative function of the body decreases, which significantly reduces the functional abilities of organs and tissues and creates certain difficulties when working with elderly and senile patients. A characteristic feature of elderly patients and one of the most significant problems that worsen the diagnosis, treatment and prevention of osteoporosis is polymorbidity.The presence of numerous and varied symptoms of concomitant diseases often does not allow quick recognition of osteoporosis and its complications. Fractures are often an accidental finding on a radiograph, for example, a wedge-shaped fracture of the vertebral body, which can be hidden for a long time under the guise of osteochondrosis. The opposite cases are possible, when, with undiagnosed oncopathology, metastases in the region of the vertebral body with a fracture can initially be regarded as a manifestation of osteoporosis. Thus, with polymorbidity, both underdiagnosis and overdiagnosis of the disease are possible, a combination of osteoporosis with other diseases with a similar clinical picture and mutual burdening of each other’s course can be observed.

Geriatric patients are characterized by the blurred course of many diseases, the presence of nonclassical symptoms or their complete absence. Osteoporosis in an elderly patient without any complaints with a vertebral fracture can be compared with the course of pneumonia without a strong fever and cough. The blurring of the clinical picture complicates the diagnostic search, and the patient seeks help from a specialist at later stages with the development of complications.

The syndrome of senile asthenia, detected in the older age group, is closely associated with the development of sarcopenia, osteoporosis and an increase in the frequency of falls and fractures by 1.2-2.8 times.Patients with senile asthenia are 1.2–1.8 times more likely to be hospitalized in comparison with the general population of elderly and senile people [2]. A characteristic feature of geriatric patients admitted to the hospital is an increase in the risk of falls with an increase in hospital bed-days, an increase in the likelihood of contracting nosocomial infections that are difficult to treat.

The next feature of geriatric patients is social and mental maladjustment associated with significant changes in the patient’s life: retirement, decreased social and physical activity, often worsening economic situation.As a result of these reasons, an elderly patient may develop depression [10].

FALLS AND FRACTURES IN THE ELDERLY

In young people, falling usually does not lead to any serious consequences, unlike elderly patients. In elderly and senile patients, falls can be caused by various reasons due to neurological disorders, poorly controlled blood glucose levels in diabetes mellitus, the use of certain drugs, for example, benzodiazepines, dizziness of various origins, various diseases of the lower extremities. Falls in older age are more likely than in younger people to lead to fractures, which reduce physical activity and increase the risk of death. Fractures in geriatric patients can occur even with normal BMD, therefore, the older the patient, the more significant the risk of fractures is. The main risk factors for fractures can be divided into internal (gender, age, etc.) and external (low lighting in the room, armchairs without handles, high steps, etc.).) [4]. When comparing a patient with reduced BMD, but no other risk factors or minimal ones, and a patient with more than four risk factors and normal BMD, the latter is considered to have a higher risk of falling, but the risk of fracture remains higher in the former. Accordingly, prevention of falls and increase in BMD becomes an important task of the attending physician. However, if a fracture occurs, then this patient, according to clinical guidelines, is diagnosed with osteoporosis and treatment begins, regardless of the results of densitomerism or FRAX (if there are no other diseases of the supporting system) [8].

A significant difference between fracture healing in young and elderly patients is associated with age-related deterioration in the recovery of damaged bone tissue. In the elderly, not only osteogenic differentiation is disturbed and reduced, but also angiogenesis due to a decrease in the activity of endothelial cells of the hemostatic pathway, growth factors, and neurochemical mediators. When angiogenesis and instability of the fracture are disturbed or limited, another mechanism is activated – endochondral ossification with the penetration of vessels and progenitor cells from the mesenchyme into the newly formed chondrogenic tissue, which leads to impaired fracture healing and the formation of cortical bone.

Mineralization and strength of bone tissue are assessed by several parameters during densitometry: bone mineral component (BMC) and BMD. Both of these parameters characterize the amount of mineralized bone tissue, however, BMC is determined by the length of the scanning path (g / cm), and BMD determines the amount of bone tissue in the scanned area (g / cm ² ). Low BMD and BMD in combination with the first fracture can trigger a “cascade of fractures” [4–9, 11]. Women are more likely than men to suffer the first and all subsequent fractures.According to the Reykjavik study, the structure of re-fractures was similar to the first, with the risk of a second fracture immediately after the first was significantly high and decreased over time, but every year there was a moderate increase in the risk of re-fracture by 5%. One year after the first fracture, the risk of recurrence was 2.7 times higher than in the general population, while there was no statistically significant difference between men and women. Along with recurrent fractures, chronic pain is a big problem, which is present in 75% of patients, in connection with which many take daily nonsteroidal anti-inflammatory drugs [7, 12].

PRINCIPLES OF TREATMENT OF OSTEOPOROSIS IN THE ELDERLY

Before prescribing treatment for elderly and senile patients, it is necessary to carefully assess the benefits and risks of the prescribed therapy. Such caution is associated with a higher incidence of drug complications in the elderly compared with patients of young and middle age, with polypharmacy in this age group, and therefore the appointment of long-term drug treatment negatively affects the patient’s adherence to therapy, with an age-related decrease in receptor sensitivity. which can affect the pharmacodynamics of the drug.The patient and, if possible, relatives should be interviewed about the need for prescribed therapy, its risks and complications [10].

Treatment of osteoporosis has several main directions – increasing the strength of bone tissue, reducing or completely stopping bone loss, normalizing bone remodeling processes, reducing the risk of falls and fractures, and improving the patient’s functional activity. First and foremost, an important component of the treatment of patients with osteoporosis is non-drug treatment based on lifestyle changes.For some patients, in order to increase the BMD with a slight decrease in it, it is enough to adjust the diet and increase the walking time by half an hour. There are educational programs and schools of osteoporosis that educate patients about osteoporosis and prevention of primary and recurrent fractures [4, 10].

Calcium and vitamin D preparations containing cholecalciferol are an essential component of osteoporosis therapy along with pathogenetic therapy, having a positive effect on balance and muscle strength and thus reducing the risk of falls and fractures [3].Active metabolites of vitamin D or their analogs can be prescribed to patients with severe hypocalcemia or end-stage chronic renal failure according to absolute indications or to elderly patients with a glomerular filtration rate of less than 60 ml / min and a high risk of falls according to relative indications. Taking these drugs significantly increases the absorption of calcium in the intestine, and reduces the level of parathyroid hormone in the blood and requires frequent monitoring of the level of calcium in the blood serum and urine.Senile osteoporosis can be accompanied by malabsorption syndrome, when calcium absorption worsens and sensitivity to vitamin D receptors decreases, which determines the need to prescribe active vitamin D metabolites also in this group of patients [3, 4, 6].

As a basic medical pathogenetic therapy, drugs are used that can be conditionally divided into antiresorptive drugs, which suppress bone resorption through the effect on osteoclasts, increase bone mineralization, and anabolic drugs, which increase bone tissue formation, increasing bone mass and improving bone architectonics.Antiresorptive drugs include bisphosphonates, selective estrogen receptor modulators, denosumab. The anabolic drug presented in domestic practice is teriparatide. For the treatment of osteoporosis in men, nitrogen-containing bisphosphonates (alendronate, zoledronic acid), denosumab and teriparatide are used. For the treatment of postmenopausal osteoporosis, you can also use a number of drugs from the bisphosphonate group – risedronate, ibandronate.

The choice in favor of this or that drug depends on the severity of osteoporosis, the presence of contraindications, and the patient’s preferences.So, in the case of bisphosphonates, intravenous and oral administration of drugs is possible. However, there is no data on the effectiveness of ibandronate in the prevention of fractures in the elderly [3]. The use of zoledronic acid in the HORIZON Pivotal Fracture Talk Study (HORIZON-PFT) has been shown to be effective in postmenopausal women with an average age of 73 years in reducing the risk of vertebral, hip and extravertebral fractures. In the 2010 pooled analysis of the HORIZON PFT and HORIZON-RFT trials, the reduction in the risk of hip fracture was not statistically significant in patients ≥75 years old, which could be due to insufficient sample size or other extraskeletal risk factors for hip fractures that increase with age. …Risedronate also did not show a significant reduction in the risk of hip fractures in the 80+ group. The data obtained may be related to the fact that bisphosphonates, while increasing BMD, do not affect extraskeletal fracture risk factors, such as gait disturbances, balance and the risk of falling, which are significant in the elderly group [3].

Denosumab in the FREEDOM study in individuals ≥75 years of age demonstrated a safety and a significant reduction in the risk of hip fractures by 62%, vertebrae and extravertebral fractures to the same extent as in younger individuals [3].

The use of strontium ranelate in women with an average age of 76.7 years reduced the risk of vertebral and extravertebral fractures by 31% after 5 years; however, the presence of an increased risk of cardiovascular events, incl. myocardial infarction, and venous thromboembolism, does not allow its use in persons over 75 years old [3].

Teriparatide is indicated for the treatment of predominantly severe forms of osteoporosis (one or more fractures of the vertebral bodies, fracture of the proximal femur, multiple repeated fractures of the skeletal bones) with a duration of treatment up to 18-24 months, after which bisphosphonate therapy (alendronate) can be continued, since this scheme leads to a further increase in BMD in postmenopausal women [4, 7, 13].However, an analysis carried out in a group of people over 75 years of age to study the effect of teriparatide revealed that the risk of vertebral fractures and extravertebral fractures did not differ statistically significantly in young and elderly patients [14]. There was no significant difference in drug tolerance. Thus, age does not affect the safety and efficacy of teriparatide in fracture prevention. The need for daily subcutaneous administration of the drug creates certain difficulties for the elderly. Another anabolic drug, abaloparatide, demonstrated in the ACTIVE comparative study a consistent reduction in the risk of vertebral and extravertebral fractures in different age groups, but it has not yet been registered in Russia [15].

MEASURES FOR PREVENTION OF OSTEOPOROSIS

The most important thing in the practice of a geriatrician is to prevent the development of the disease. For this, the patient’s lifestyle is primarily important. If the patient does not have the necessary minimum of physical activity and there is no diet corresponding to his condition, then the risks of developing osteoporosis, falls and fractures increase sharply. In the absence of the necessary physical activity, the patient’s muscle strength decreases, and rare excessive activity only puts excessive pressure on the bones of the skeleton.Moderate regular exercise is required to maintain normal bone density. So, for example, of physical activity, the most effective type is walking and some exercises for balance and increasing muscle strength, but jumping and running, which can provoke a fall, are prohibited. The diet should include foods rich in calcium, magnesium, and completely stop smoking and drinking alcohol. For those at high risk of developing a hip fracture, wearing a permanent hip protector is recommended.

The Re-fracture Prevention Service primarily focuses on the prevention of falls. To reduce the risk of falls, first of all, it is worth treating or controlling concomitant diseases (hypertension, anemia, diabetes mellitus, neurological diseases, etc.). The patient should be interviewed about the fact that various external factors (high steps, etc.) can lead to a fall and further greatly reduce the quality of life. To reduce the risk of falling, the patient can use a cane, he should wear more stable shoes with a low platform or low heel.

Low VO2 max is almost always associated with sarcopenia, which corresponds to a lower ability to carry out daily activities. Taken together, this can affect a higher likelihood of developing complications after a fracture, and an increase in the cost of health care resources. And in this case, the best prevention is the optimization of nutritional status and replenishment of nutritional deficiencies, in particular, an increase in the protein content in the diet up to 1.5 g / kg of body weight. After a fracture has occurred, an important task for the doctor is to effectively relieve the patient.Not only non-steroidal anti-inflammatory drugs, but also teriparatide affect the reduction of pain in the back. It is necessary to quickly prescribe anti-osteoporotic drug therapy, as short-term immobilization as possible, after which physiotherapeutic treatment and early activation of the patient should be carried out already at the stage of bed rest. All procedures performed must be agreed with a traumatologist [3, 4, 8, 16].

CONCLUSION

In old age, the prevalence of osteoporosis and fractures associated with it increases, especially among patients with senile asthenia.The significant socio-economic and medical burden of fractures in the elderly requires a mandatory widespread diagnosis of osteoporosis, fractures and immediate treatment in this age group. Along with the use of calcium and vitamin D, which are important components in the treatment of osteoporosis in old age, compulsory pathogenetic treatment is necessary, which will further reduce the risk of fractures, especially vertebral fractures. In older people with senile asthenia with established osteoporosis, treatment may be even more effective than in younger patients.

FURTHER INFORMATION

Conflict of interest . The authors declare no obvious and potential conflicts of interest related to the publication of this article.

1. Dent E, Morley JE, Cruz-Jentoft AJ, et al. Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. J. Nutr. Health Aging.2019; 23 (9): 771-787. doi: https / doi.org / 10.1007 / s12603-019-1273-z.

2. Tkacheva ON, Runikhina NK, Kotovskaya Yu.V., et al. Management of patients with senile asthenia in primary health care. Textbook for doctors – M .: Publishing house of the Russian Academy of Medical Sciences, 2016. [Tkacheva ON, Runikhina NK, Kotovskaya YuV, et al. Vedenie pacientov so starcheskoi asteniei v pervichnom zvene zdravooxranenia. Uchebnoe posobie dlya vrachei.Moscow: Izd-vo RAMN; 2016. (In Russ).].

3. Gielen E, Bergmann P, Bruyère O, et al. Osteoporosis in Frail Patients: A Consensus Paper of the Belgian Bone Club. Calcif. Tissue Int. 2017; 101 (2): 111-131. doi: https / doi.org / 10.1007 / s00223-017-0266-3.

4. Clinical guidelines for the prevention and management of patients with osteoporosis.2nd edition, supplemented. / Ed. Lesnyak O.M. – Yaroslavl: IPK “Litera”, 2013. [Lesnyak OM, editor. Klinicheskie rekomendacii po profilaktike i vedeniju bol’nyh s osteoporozom. Izdanie 2-oe, dopolnennoe. Yaroslavl ‘: IPK “Litera”; 2013 (In Russ).].

5. de Liefde II, van der Klift M, de Laet CEDH, et al. Bone mineral density and fracture risk in type-2 diabetes mellitus: the Rotterdam Study. Osteoporos.Int. 2005; 16 (12): 1713-1720. doi: https / doi.org / 10.1007 / s00198-005-1909-1.

6. Pigarova EA, Rozhinskaya L.Ya., Belaya Zh.E., et al. Clinical guidelines of the Russian Association of Endocrinologists for the diagnosis, treatment and prevention of vitamin D deficiency in adults // Problems of Endocrinology. – 2016. – T. 62. – No. 4. – C. 60-84. [Pigarova EA, Rozhinskaya LY, Belaya JE, et al. Russian Association of Endocrinologists recommendations for diagnosis, treatment and prevention of vitamin D deficiency in adults.Problems of Endocrinology. 2016; 62 (4): 60-84. (In Russ).] Doi: https / doi.org / 10.14341 / probl201662460-84.

7. Lau AN, Adachi JD. Bone Aging. In: Nakasato Y, Yung R, editors. Geriatric Rheumatology. New York: Springer, NY; 2011, p. 11-17. Doi: https://doi.org/10.1007/978-1-4419-5792-4.

8. Melnichenko G.A., Belaya Zh.E., Rozhinskaya L.Ya., et al. Summary of clinical guidelines for the diagnosis and treatment of osteoporosis // Osteoporosis and Osteopathy. – 2016. – T. 19. – No. 3. – S. 28-36. [Melnichenko GA, Belaya ZE, Rozhinskaya LY, et al. Summary of Clinical Guidelines for the Diagnosis and Treatment of Osteoporosis of the Russian Association of Endocrinologists. Osteoporosis and Bone Diseases. 2016; 19 (3): 28-36. (In Russ).]. doi: https / doi.org / 10.14341 / osteo2016328-36.

9.Karlsson MK, Magnusson H, von Schewelov T, Rosengren BE. Prevention of falls in the elderly — a review. Osteoporos. Int. 2013; 24 (3): 747-762. doi: https / doi.org / 10.1007 / s00198-012-2256-7.

10. Rozhinskaya L.Ya. Diagnostics and treatment of osteoporosis // Clinical gerontology. – 2007. – T. 13. – No. 2. – S. 37-46. [Rozhinskaja LYa. Diagnostics i lechenie osteoporoza // Klinicheskaja gerontologija. 2007; 13 (2): 37-46 (In Russ).].

11. Qi H, Sheng Y, Chen S, et al. Bone mineral density and trabecular bone score in Chinese subjects with sarcopenia. Aging Clin. Exp. Res. 2019; 31 (11): 1549-1556. doi: https / doi.org / 10.1007 / s40520-019-01266-8.

12. Johansson H, Siggeirsdóttir K, Harvey NC, et al. Imminent risk of fracture after fracture.Osteoporos. Int. 2016; 28 (3): 775-780. doi: https / doi.org / 10.1007 / s00198-016-3868-0.

13. Mazurov V.I., Lesnyak O.M., Belova K.Yu., et al. Algorithms for choosing therapy for osteoporosis in the provision of primary health care and the organization of preferential drug provision for certain categories of citizens eligible for state social help. Systemic review and resolution of the Expert Council of the Russian Association for Osteoporosis // Preventive Medicine.- 2019. – No. 1. – S. 57-65. [Mazurov VI, Lesnyak OM, Belova KY, et al. Algorithm for selection of drug for osteoporosis treatment in primary care and in organization of provision with medicinal products of citizens eligible for state social assistance. Review of the literature and position of Russian Association on Osteoporosis Expert Council. Profilakticheskaya meditsina. 2019; 22 (1): 57. (In Russ.)] Doi: https / doi.org / 10.17116 / profmed20192201157.

14.Boonen S, Marin F, Mellstrom D, et al. Safety and Efficacy of Teriparatide in Elderly Women with Established Osteoporosis: Bone Anabolic Therapy from a Geriatric Perspective. J. Am. Geriatr. Soc. 2006; 54 (5): 782-789. doi: https / doi.org / 10.1111 / j.1532-5415.2006.00695.x.

15. Cosman F, Hattersley G, Hu M-y, et al. Effects of Abaloparatide-SC on Fractures and Bone Mineral Density in Subgroups of Postmenopausal Women With Osteoporosis and Varying Baseline Risk Factors.J. Bone Miner. Res. 2017; 32 (1): 17-23. doi: https / doi.org / 10.1002 / jbmr.2991.

16. Fahrleitner-Pammer A, Langdahl BL, Marin F, et al. Fracture rate and back pain during and after discontinuation of teriparatide: 36-month data from the European Forsteo Observational Study (EFOS). Osteoporos. Int. 2010; 22 (10): 2709-2719. doi: https / doi.org / 10.1007 / s00198-010-1498-5.

90,000 8 rules to help avoid a hip fracture in adulthood

Fracture of the femoral neck is a dangerous injury that literally divides a person’s life into before and after receiving it.The restoration of such damage takes many months and requires not only medical treatment, but also psychological adaptation. It is especially difficult for the elderly to endure a hip fracture, so it is important to engage in prevention with them. In the private boarding houses of the Senior Group, special attention is paid to this issue.

According to the data of the Russian Osteoporosis Association, a hip fracture occurs every 5 minutes in our country. Moreover, in every third case, a person needs patronage care on an ongoing basis, and every fourth case, unfortunately, ends in death as a result of the development of complications.Undoubtedly, there is a chance to return to the old life after injury, but it is preferable to prevent possible risks.

Causes of hip fracture

Most often, injury occurs as a result of:

• Falls. In many elderly people, coordination of movements deteriorates, gait becomes unsteady and slow, and the speed of physical reaction to imbalance decreases. All this causes falls. The location and setting of the injury does not matter.An elderly person may fall at home, on the street, in any public place, tripping over an obstacle, slipping or feeling unwell. Falling from a height during housework or on a personal plot (from a chair or a ladder) is not excluded.
• Unsuccessful movements. Loss of balance, excessive physical exertion after a long break, any external influence (the dog pulled the leash, the little grandson grabbed the hand, etc.)). Sports are also included, so it is recommended that older people exercise under the supervision of a specialist.

• Diseases. A hip fracture can occur without strong external influences and unsuccessful falls. The cause of injury can be osteoporosis, tumor, osteochondrosis, herniated disc, arthrosis of the knee or ankle joint, spondyloarthrosis, etc. Bad habits and excess weight can aggravate the disease and, accordingly, increase the risk of hip fracture.If you do not take action in a timely manner, injury can occur even as a result of the usual rolling over in bed from side to side.
• Strokes. A hip fracture can result from road traffic accidents, work-related injuries and other external influences that cannot be foreseen and prevented. But even in this case, there is a chance to do without a fracture if the elderly person is actively involved in prevention and health promotion.

Other causes of injury include poor vision, a sedentary lifestyle, unbalanced nutrition, menopause in women, diseases of the nervous system, which are accompanied by impaired coordination of movements, etc.

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Prevention of trauma 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, because of personal carelessness and negligence, or through someone’s criminal negligence and irresponsibility, are injured, become disabled, and are deprived of their lives.

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

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

External reasons are associated with improper organization of safe movement, low safety at home, uncomfortable shoes, lack of aids to mobility (walking sticks, walkers), etc.p.

In old and old age, gait problems appear against the background of neurological and vascular diseases, pathology of the musculoskeletal system: muscle atrophy, joint pain, loss of 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 a little (no more than 4 hours a day) in an upright position, as well as in those who cannot sit up and stand up without assistance, who are depressed, depressed, who suffers from syncope (short-term blackouts).

Factors such as ice in winter, uneven road surface, poor illumination, lack of outside help from people who need it, etc. are of no small importance.

50% of falls occur at home, especially in the bathroom and bedroom. Many older people are injured without witnesses, which makes it impossible for them to get help quickly.

Treatment of the consequences of serious injuries sustained under various circumstances is costly for both the patient and his family.A person has to go through mental trauma: to regain confidence in their physical strengths, to overcome the fear of repeated falls. The consequences of fractures are often the loss of independence, the need to hire a nurse, and ask relatives and friends for help. The limitation 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 thermoregulation disorders – hypothermia and pneumonia. Such patients often develop depression and suicidal thoughts.

In such a period, it is especially important to pay attention and care for the victim, his relatives and friends.

Recommendations for the prevention of injuries to older people.

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 eye and hearing tests are required to order stronger glasses or hearing aids in time.
• Performing home balance and muscle exercises as directed by a physician and daily walking.
• Maintaining the optimum temperature in the living room, since significant temperature drops impair 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, in order to prevent falls during walks, it is advisable to use a cane or walk accompanied by loved ones, this is especially important when crossing the street, when going downstairs and going upstairs.
• When returning home at night, it is advisable to be accompanied by acquaintances or friends, while choosing a route through crowded and lighted places.
• It is important to choose the right footwear. It should be loose, but not too large, soft and with grooved soles.
• An important role is played by the furniture in the room where the elderly person lives. So, the bed should be at least 60 centimeters, the chairs should be shallow, soft, the backs of the chairs – high so that there is support for the head. When getting out of bed, you should avoid sudden movements.
• Injury can often be obtained during washing, bathing, therefore, relatives or service personnel should collect water in the bathroom. The bathroom should be equipped with handrails, support and a special bench that is attached to the edge of the bathtub.There must be a rubber mat on the bathroom floor.
• If an elderly person is admitted to the hospital, he must be familiarized with the location of the ward, treatment room, toilet, dining room.

Elderly people should always calculate their strengths and capabilities of the body.

Reducing injuries among the elderly is possible not only if the state cares about this category of the population, but also if citizens themselves are attentive to their health and safety.

Clinical Study Elderly: Experimental, Control – Clinical Trials Registry

90,000 Article causes and consequences of the fall of an elderly person

It so happens that older people fall.This is a fairly common occurrence for elderly people. They lose their balance, resulting in a fall. The consequences of such falls can be different. Someone will get off with fright, someone will have a fracture, and the saddest thing can be a fatal outcome. The real consequences are not entirely obvious to themselves and those around them. “It happens to whoever” they think, rising from the ground. They often hide what happened so that they are not accused of helplessness or sent to a nursing home. You should not be silent about this, and even more so endure discomfort or pain.You must immediately consult a doctor in order to carry out the necessary diagnostics and get help.

Causes of falls

There are several reasons that cause the fall of elderly citizens, namely:

• External factors
• Internal factors
• Random factors

Let’s take a closer look at the above factors.

External factors are external causes or circumstances. For example, such as ice, wet asphalt, unfamiliar territory, area. It can also be uncomfortable clothes, shoes, a narrow passage, foggy glasses, objects on the way, poor lighting.

Internal factors are the state of health of the elderly person. With age, as a rule, the body becomes weaker, the work of the systems responsible for visual acuity, maintaining balance while walking, orientation in space, etc. is disrupted.In addition, with age, dexterity, physical strength, endurance, the ability to maintain balance, balance in difficult places, the ability to properly group when falling, go away.

Random factors are non-standard situations. For example, a fall can be when moving in the dark at night around an apartment or house, when crossing a busy road, when performing complex tasks that require a lot of effort, when trying to do everything at once. It happens that a person is in a hurry and excessive fuss has caused disorientation in space.

Diseases that can lead to falls

There are a number of conditions that can lead to falls:

• low blood pressure
• epilepsy
• heart disease
• circulatory disorders
• chronic diseases
• vision problems
• Parkinson’s disease
• dementia
• problems with the vestibular apparatus
• violation of sensory perception, etc.

Drugs as a Cause of Falls

An older person’s medication is often the cause of falls. There are 3 categories of drugs that require special attention:

• Drugs that affect brain activity. Usually these are psychotropic drugs, such as drugs for insomnia, dementia, depression.

• Pressure medications.
• Drugs that lower blood sugar levels.

When taking the above drugs, it is imperative to take into account the side effects and carefully monitor your wards.

Falls

At home, this is most often a bathroom or toilet. Some houses do not have an elevator and a staircase may be the place of the fall.

It happens that old people fall in clinics or hospitals, where they often go to the attending physician or undergo treatment in a hospital.If an elderly person often falls, it is imperative to notify the medical staff of the hospital where he is admitted for treatment.

On the street, elderly people often fall in winter on ice and other slippery places: sidewalks, wet paths. This can happen on or off public transport. If a person falls on a busy street, then there is a chance that they will be helped or an ambulance will be called if necessary. It is bad if the fall occurs in the winter in an open space without witnesses.There is a risk of frostbite.

Symptoms

If the fall is caused by internal factors such as the physical health of an old man, the symptoms before the fall may be as follows:

• dizziness
• heart palpitations
• light-headedness
• darkening of the eyes
• heat.

If the fall happened, then it is good if it passes without a trace.Unfortunately, more often you can observe such consequences as: bruises, bruises, sprains, dislocations and fractures, ligament ruptures, scratches. In severe cases, internal organs are damaged. Sometimes a person loses consciousness, which can lead to head injury.
If a person falls and cannot stand up, this can lead to the fact that the body loses a lot of fluid, the body temperature drops significantly, bedsores form, and pneumonia occurs.

Diagnostics

In order to determine what exactly caused the fall, the doctor must identify the symptoms that the patient had just before the fall.For example, nausea, dizziness, darkened eyes, rapid heartbeat, shortness of breath, etc.
After that, a number of mandatory procedures will be carried out:

• Blood pressure measurement
• Heart rate analysis
• Determination of muscle tone, namely examination of the limbs and back
• Vision Diagnostics
• Checking the nervous system
• Testing the patient’s motor activity: walk through the office, climb the stairs, close your eyes, touch the tip of the nose.

Based on the results of the general examination, a more detailed examination may be ordered in areas where the elderly person has poor health or where the doctor had doubts during the initial examination. If the heart is weak, an ECG will be ordered. If there is a disease of the nervous system, computer diagnostics or magnetic resonance imaging of the head will be prescribed.
If the fall occurred due to some external influence and this is not related to the physical condition of the person, the diagnosis is not carried out.But it is imperative to make sure that the person feels good and the loss of balance did not entail any injury.

Complications

After a fall, an elderly person has a significantly increased risk of bone fracture. Often this is a fracture of the hip or vertebrae. Despite the fact that fractures do not pose any serious danger to the body, and bone fusion is not a difficult operation, the picture looks a little different for an elderly person.The main difficulty is that in old age bones grow together much more slowly than in young people, since in old people the process of metabolism and blood supply to skeletal tissue is slowed down. In addition, with a fracture, bed rest is often prescribed, which leads to the fact that a person is immobilized most of the time. Lack of physical activity and being in bed adversely affects both the physical and psycho-emotional state of the elderly person.Such patients feel helpless, complain, doubt their recovery and do not believe that they can return to their usual way of life. In addition, in the absence of physical activity, there is a risk of bedsores and blood clots. This, in turn, can be a deadly condition.

The danger also lies in the fact that often an elderly person is not able to get up on his own after a fall. And prolonged immobilization can lead to sad consequences. The body becomes dehydrated, bedsores, vascular blockage, hypothermia, pneumonia can form.

Often, after a fall, older people experience reduced mobility and can be difficult to regain. Someone cannot immediately return to life after bed rest, as there are sensations as if the limbs have atrophied. In addition, the psychological factor matters. The fear arises that a similar situation will arise again. Weakness appears, the risk of ossification of the limbs increases. One way or another, but the level of mobility is significantly reduced.

Doctors really advise avoiding some of the usual activities during the recovery period, such as cleaning, shopping, etc.

How to get up

No one is immune from falls, much less pensioners. In case of a fall, there should be clear instructions on what to do in your head. It is necessary to inform the person what to do in such a situation, when misfortune happened, and there was no one nearby. All people, not only the elderly, are lost in such situations, freeze and do not know what to do. First of all, you need to remember that you should roll over on all fours and crawl to the nearest bench, tree or post.You should also immediately call your loved ones and report the incident. It is necessary to provide the old man with a mobile device. You can also insert a chip into your phone or download location tracking software. If a person falls and gets disoriented in space, you can always track his location and come to the rescue.

Prevention

To prevent falls in old age, you need to take preventive measures, such as:

• Comfortable shoes.For old people, comfortable shoes with a closed toe and a fixed heel with a small heel are suitable. Classic home slippers in this case are dangerous, since the foot can simply slip out of the slipper and a person stumbles. On the street you also need comfortable, comfortable shoes, easily fastened and fixed on the foot. It is better to choose models with a fastener or Velcro. The laces will add extra complexity.

• Unobstructed at home.Care must be taken to ensure that all passages are clear of any obstructions. It is necessary to remove all wires and cords that interfere with free movement around the apartment. They often lie in the aisle. If there are extension cords, then their number should be minimized so that the space is as free as possible.

• Correct lighting. It is necessary to provide good lighting so that everything can be seen as clearly as possible at any time of the day. If an elderly person lives in his house, then it will be necessary to take care of good lighting of the local area.It is also necessary to check that the surface of the steps is non-slip. If it slips, but it is necessary to lay an anti-slip mat.

• Convenient location of essentials. As you know, older people often wake up at night. Someone is reading, someone is taking pills, someone wants to visit the restroom. All these actions should be simplified as much as possible at night. It is advisable to make a night light with an easily accessible power button, put a bedside table with all the necessary medicines and a glass of water, put a phone on the nightstand.Make an emergency call button in your phone to call an ambulance with one touch if necessary.

• Order. Ensure order in the apartment, remove items from the floor that interfere with the movement of the elderly person. Move all obstacles or decorations to the corners.

• Bathroom and restroom fittings. The bathroom and toilet should be equipped with handrails where additional support is needed.

In addition, you should think about what other daily activities should be simplified as much as possible.For example, replace a wired telephone with a wireless one, put a boiler for heating water, so that during the period when hot water is turned off, the old man does not have to carry pots of hot water. If an elderly person has already fallen and is at home, it is necessary to ensure complete rest, exclude trips to the grocery store and any other activities that require physical exertion.

The main thing to remember is that prevention and prevention of such situations is fundamental in this matter.It is much more difficult then to eliminate the consequences of the fall of an elderly person than to warn him against it. Remember this when organizing the life of an elderly person. It is necessary to make his life as convenient, comfortable and safe as possible, to protect him from possible dangers.

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Low blood pressure in an elderly person: treatment and prevention

Why low blood pressure in an elderly person is no less dangerous than high pressure

Both conditions are dangerous – hypotension and hypertension.Doctors cannot give a definite answer, which is worse – high blood pressure or low. For a long time, there was an opinion that only high blood pressure is dangerous, since it provides a serious load on the heart and this negatively affects its functioning. That is why the elderly with hypertension are often diagnosed with cardiovascular diseases, they often suffer from strokes, heart attacks and other complications.

However, very low blood pressure in an elderly person is no less dangerous – with a lack of oxygen, the brain, heart, kidneys, and gastrointestinal tract cannot function normally.As a result, there is a gradual death of organ cells.

Among the complications of hypotension are:

1. Injuries sustained by the elderly during fainting. They are often very strong.
2. Ischemic stroke. It becomes a consequence of a chronic lack of blood supply.
3. Cardiogenic shock, myocardial infarction. They occur when there is insufficient blood supply to the heart.
4. Senile dementia (dementia). It develops as a result of a violation of the thought process due to a frequent drop in blood pressure.
5. Loss of limb sensitivity in the elderly. It becomes a consequence of failures occurring in the venous and arterial blood supply.

Long-term hypotension can cause severe hypertension.

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The main signs of “lazy pressure”

Many people have low blood pressure – a physiological feature.They feel great and live with hypotension for many years, especially women of thin build. It is believed that cardiovascular pathologies “bypass them”.

The very first bell for “ordinary mortals” is manifested by the unusual chilliness of the limbs, flashes and “flies” flickering in the eyes. The main symptoms of hypotension are shown in Figure .

In young patients, low blood pressure, as a rule, is associated with the reasons provoking its decrease.The exception is the most alarming symptom – fainting, leading to accidents and injuries. This condition requires immediate medical attention. But hypotension is especially dangerous for elderly people .

Moreover, a decrease in diastolic (lower blood pressure) is more dangerous than a drop in systolic (upper blood pressure), which can lead to disturbances in the blood supply to the brain and kidneys, provoke renal failure and the development of stroke.

Causes of low blood pressure in the elderly

Low blood pressure in the elderly can be either a primary, underlying disease, or a symptomatic consequence of other diseases.Primary hypotension is called when this condition is not accompanied by other diseases. Otherwise, we are talking about symptomatic hypotension.

Many people are interested in why low blood pressure occurs in an elderly person, what is the reason for this condition. It is difficult to figure out what to do when the diastolic pressure is low. The causes in the elderly are directly related to the type of hypotension. The acute form is a consequence of heart attacks, blood loss, intracardiac blockade, severe arrhythmias, and allergic reactions.In case of acute hypotension, it is important to provide the person with first aid on time.

Primary hypotension is an independent disease manifested as neurocirculatory asthenia.

Physiological hypotension is a hereditary disease, in other words, it is the body’s predisposition to low blood pressure. An elderly person is already accustomed to this condition, and since the indicators are not much lower than the norm, they are practically the norm for low blood pressure in older people.

The main cause of low blood pressure in an elderly person is prolonged psycho-emotional stress, which generates neurosis of the vasomotor centers of the brain.Severe stress, in which a person is for a long time, causes a drop in pressure, and, as a result, primary hypotension. It is also possible to develop this disease due to an overdose of drugs for hypertension. Another reason for the occurrence of hypotension is the lack of vitamins B5, C, E.

Reasons for primary hypotension:

• frequent neuroses;
• psychotrauma;
• chronic lack of sleep and fatigue;
• depressive conditions of a person and apathy for everything.

Causes of symptomatic hypotension:

• gastric ulcer;
• arrhythmia;
• rheumatism;
• anemia;
• osteochondrosis of the cervical spine;
• circulatory problems;
• heart failure;
• hepatitis, etc.

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Symptoms of hypotension

A person is ready for physiological hypotension, so strong discomfort does not bother him.

For secondary hypotension, the following are characteristic:

• Dizziness,
• Weakness, drowsiness and lethargy,
• Severe sweating,
• Pale skin,
• Fainting.

The following conditions may occur:

• Pain in the frontal and temporal regions;
• Unhealthy heart rate;
• Feeling of lack of air;
• Darkens in the eyes with sudden movements;
• Decrease in performance;
• Apathy;
• Increased discomfort due to changes in the weather.

Critical low blood pressure in an elderly person: first aid

Low diastolic pressure in the elderly is a dangerous condition, so the first thing to do is call an ambulance. In the process of waiting for medical workers, if the patient has already lost consciousness or it seems that this may happen to him, it is necessary to provide assistance on his own, in particular:

• put an elderly person on his back;
• open the window to provide fresh air;
• Unbutton the collar of the shirt to free the chest and neck from clothing;
• if a person is conscious – give him drops from hypotension;
• Apply a rubbing massage from the ankles upwards.

There is not always a medicine at hand that is recommended for low blood pressure in the elderly, so you can use improvised means – give a person strong coffee, give 2 tablets of caffeine-containing citramone. But it is imperative to clarify whether a patient with low blood pressure has heart disease and whether he can use drugs that thin the blood.

You can help a person in a similar situation and slightly increase blood pressure using the acupuncture method.Find a point under the nose, press on it with your finger, hold for a minute, release and repeat such manipulations 5 to 10 times. Another way is to raise a person’s legs above the head, for example, throw them on the headboard of a bed or sofa, put high pillows under their feet, etc. All this can be done while waiting for the arrival of doctors. Doing this will help prevent loss of consciousness from low blood pressure and potential injury from a fall.

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The difference between products for men and women

People suffering from hypotension experience not only discomfort.The disease can cause more serious diseases and manifest itself in different ways in different sexes. So, women have menstrual irregularities, men experience sexual problems.

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Pressure 100/65 for men and 95/60 for women are averages and serve as a guideline. When they change towards even lower indicators, a doctor’s consultation is necessary in order to avoid further complications.

Scientists have found that women suffer from hypotension much more often than men. According to the statistics of men, hypotonic patients are 60% less than the fairer sex.

Speaking about a set of products that can increase blood pressure, it is worth noting that there is no special diet for hypotensive patients as such.

Every organism is unique, so the same set of foods does not always have the same effect. To achieve the maximum therapeutic effect in hypotension, it is necessary to combine food.

Based on the above, the reduced pressure diet for men and women is selected individually by the attending physician. This takes into account not only the physiological characteristics of the body, but also the level of physical activity. However, there are several practical tips that should become the rule and be carried out unquestioningly:

• the daily ration should be divided into several receptions;
• It is advisable to eat at the same time, observing a certain interval, for example, every 3 hours;
• The menu must contain products recommended for increasing blood pressure.

Hypotonic patients should fill their daily menu with sufficient amounts of water and salt. This simple advice will eliminate the disease and quickly stabilize the pressure.

How to increase low blood pressure in an elderly person at home

If blood pressure suddenly drops, but the indicators are not critical, do not panic. We will tell you how to increase low blood pressure in an elderly person at home.

1. One of the simplest and most widely known ways to increase pressure is to drink strong coffee.Caffeine promotes vasodilation, helps to give the body a boost of vigor. The drink is especially good for those elderly people who rarely drink it, about once a week. For those who drink coffee every day, it will be more difficult, because it will not be possible to obtain the desired effect with low blood pressure if the body is already accustomed to caffeine.
2. Strong sweet tea will help raise blood pressure and tone the body.

3. Ordinary salt comes to the rescue. Eating something salty, or even just putting some salt on the tongue, can help the elderly relieve their condition.
4. Honey combined with cinnamon is considered one of the fastest ways to increase low blood pressure, and the effect remains for a long period. Take half a teaspoon of cinnamon and dissolve it in a glass of boiling water, add one spoonful of honey there. Wait half an hour for the drink to infuse, after which you can drink it. Or you can make it easier: spread honey on a piece of bread, sprinkle with cinnamon on top and eat such a sandwich.
5. You can eat something fatty, of course, it is better not to eat fatty foods too often, but if there is no other way to cope with a sharp drop in pressure, then you can use this one.
6. Consuming glucose or refined sugar can also help increase blood pressure. Glucose is sold in pills in pharmacies.
7. Cognac or red wine, but it is important to know when to stop – no more than 50 grams per day. Usually cognac is added to coffee or tea.

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Why does the upper pressure go down?

Systolic blood pressure is considered low if the reading is below 120 mm. But if the pressure does not fall below 100/60 (70), such indicators can be recognized as a variant of the norm, if they are considered “working” for a particular person, observed throughout life.

A sudden drop in upper pressure, for example, up to 100/60, may indicate disturbances in the functioning of the heart, kidneys, and nervous system. This phenomenon can be short-term, triggered by stress or overwork. Blood pressure returns to normal after lifestyle changes and non-drug therapy.

Most often, the upper pressure drops below normal, and the lower one remains the same – these are signs of vegetative vascular dystonia. This is a condition that develops due to disturbances in the functioning of the nervous system, more precisely, its vegetative part, and manifests itself in a number of symptoms.Quite often, this pathology is observed in adolescents, people who are often stressed, and pregnant women. The neurologist treats this pathology with medication and non-medication methods.

Traditional drugs for hypotension

We have already figured out what low blood pressure means in an elderly person. This is a serious ailment, and often it is impossible to cope with it using only home methods, because requires the use of special drugs that normalize blood pressure.The most popular remedy for hypotension remains caffeine.

But other groups of drugs are also used:

• Psychomotor stimulants.

Help an elderly person to cope with weakness, chronic fatigue syndrome. Thanks to stimulants, the hypotonic becomes efficient, lethargy and drowsiness disappear, and the normal state is normalized. The most popular drugs from this drug group are: Sidnofen, Mezocarb, Sidnocarb, etc.

• Analptics

Improve the functioning of the cardiovascular system, respiratory organs. After their use, elderly people with low blood pressure begin to feel better, their overall tone and mood rises. This group includes the following drugs: Cordiamine, Centedrine and similar.

• Adrenomimetic drugs

These drugs are necessary to increase both diastolic and systolic pressure, so their use is justified only in very difficult cases.They are designed to ensure normal blood circulation. These are Regulton, Gutron, Fetanol, etc.

• Nootropic drugs

This group of drugs is designed to optimize metabolic processes in the central nervous system and normalize blood circulation. Thanks to the use of such drugs, the memory of an elderly person improves, and the learning process is facilitated. Phenibut, Pantogam, Piracetam, Aminalon, etc. are considered effective nootropic agents.

We must not forget about the need to take complex vitamin preparations, especially when it comes to an exacerbation of the disease.

If medication for low blood pressure in the elderly is carried out at home, the dosage prescribed by the doctor must be strictly observed. If the condition after taking the medication has worsened, then immediately contact a specialist to adjust the treatment, taking into account the characteristics of the course of the disease in each individual case.

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Traditional methods of dealing with low blood pressure

There are many popular ways to deal with low blood pressure, but we must not forget that different people can react to them in different ways.

• Helichrysum broth

For its preparation, take a tablespoon of Helichrysum flowers, pour boiling water (250 ml) and keep in a water bath for 15 minutes. After that, you can strain the broth and take. This amount of ingredients is based on a daily dose. The effect can be obtained if you drink the broth three times a day – 1/3 cup before each meal.

• St. John’s wort decoction

It is advisable to consult with a specialist before taking St. John’s wort decoction with low blood pressure.The recommended daily intake of the decoction is no more than 250 ml, and it must be adhered to. The course of treatment is no more than a month, a decoction is prepared by analogy with an immortelle decoction.

• Infusion of calamus, burdock, chicory

This infusion is prepared from the roots of burdock, chicory and marsh calamus. 100 grams of each ingredient are crushed and mixed, poured into a liter jar, which is then poured with water to the brim. The jar should be placed in a dark place for 10 days.After the specified period, the infusion is taken in 5 drops, dissolving them in a tablespoon of water. The infusion is drunk three times a day for three weeks.

• Grape or pomegranate juice

Grape or pomegranate juice can perfectly cope with the task of increasing pressure. Of course, the best effect will be from fresh, store will not work, since it is canned. Buy dark grapes, squeeze juice from them, preferably before taking. The dosage is half a glass twice a day, the course of administration is two weeks.Pomegranate juice can help relieve dizziness and headaches.

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Bay leaf

Traditional healers recommend using bay leaves to quickly increase blood pressure. It is necessary to chop a small leaf of laurel and put it under the tongue. After five minutes, they spit it out. This remedy works instantly.

The listed recipes increase the pressure, but the effect of their use is short-lived, since they do not eliminate the cause of the disease.They can be considered as “first aid” in case of emergency. With a regular decrease in pressure, it is necessary to use traditional methods and means or folk recipes that are aimed at eliminating the cause of the pathology.

Prevention of hypotension in the elderly

To prevent the development of hypotension and related diseases, the elderly should follow a number of recommendations:

1. Try not to overwork, avoid stress.
2. Drink 1.5 to 2 liters of liquid per day.
3. Be active and mobile.
4. Walk often in the fresh air.
5. Eat more herbs, spices and salt in your food.
6. Do general strengthening gymnastics.
7. Limit hot baths by replacing them with a contrast shower.
8. Reduce the amount of carbohydrates in food to prevent spikes in blood pressure and blood sugar.