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Fall prevention at home in the elderly: 9 Ways to Prevent Falling at Home

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9 Ways to Prevent Falling at Home

One out of three seniors will fall this year, but fewer than half of them will talk with their doctors about it, according to the Centers for Disease Control and Prevention. Falls are also the No. 1 cause of injuries in seniors, resulting in hip fractures, cuts, and even serious head and brain injuries that can be fatal. And even when there’s no serious injury, a fall can still be so frightening that seniors may avoid certain activities because they’re afraid they’ll fall again.

Whether it’s slippery floors, rickety stairs, or electrical cords, some of the most common causes of falls are in the home where you might have a false sense of security. That’s why fall prevention starts with creating a safe living space.

Related: Exercises That Can Add Years to Your Life

This doesn’t have to involve a complete house remodel. You can make your home safe from falls with just a few basic changes. Senior care experts offer the following advice for preventing falls at home:

  1. Clean up clutter. The easiest method for preventing falls is to keep your home neat and tidy. Remove all clutter, such as stacks of old newspapers and magazines, especially from hallways and staircases.
  2. Repair or remove tripping hazards. Sometimes home fixtures can contribute to falls, which can then lead to back pain and other injuries. Examine every room and hallway, looking for items such as loose carpet, slippery throw rugs, or wood floorboards that stick up. Then repair, remove, or replace those items for more effective fall prevention.
  3. Install grab bars and handrails. These safety devices are crucial for going up and down stairs, getting on and off the toilet, and stepping in and out of the bathtub without injuring yourself. Gary Kaplan, DO, founder and medical director of the Kaplan Center for Integrative Medicine in McLean, Virginia, suggests installing grab bars by toilets and bathtubs and handrails in stairways and hallways. Have a handyman or family member help with this if necessary.
  4. Avoid wearing loose clothing. You want to feel comfortable at home, but baggy clothes can sometimes make you more likely to fall. Opt for better-fitting and properly hemmed clothing that doesn’t bunch up or drag on the ground.
  5. Light it right. Inadequate lighting is another major hazard. To create a home that’s more suitable for the elderly, install brighter light bulbs where needed, particularly in stairways and narrow hallways. Robert Bunning, MD, associate medical director of inpatient services at MedStar National Rehabilitation Hospital in Washington, D.C., also recommends adding night-lights in bedrooms and bathrooms for better guidance at night.
  6. Wear shoes. Socks may be comfortable, but they present a slipping risk. Preventing falls at home can be as simple as wearing shoes. You can also purchase non-slip socks that have grips on the soles of the feet if shoes are too uncomfortable.
  7. Make it nonslip. Bathtubs and showers, as well as floors in kitchens, bathrooms, and porches, can become extremely dangerous when wet. To prevent falls on slick surfaces, Dr. Kaplan recommends nonslip mats.
  8. Live on one level. Even with precautions like guardrails, stairs can present a significant falling hazard. “If possible, live on one level,” says Kaplan. “Otherwise be extra-careful when you negotiate stairs.” If it’s not possible to live on one level, try to limit the trips you take up and down the stairs.
  9. Move more carefully. Dr. Bunning explains that many people fall at home by moving too quickly from a sitting to a standing position and vice versa. Preventing falls like this is as easy as taking your time. “All you have to do is pause after going from lying down to sitting and from sitting to standing,” he says. “Also take a pause before using the railing on stairs, whether going up or down.”

For the elderly, fall prevention means injury prevention. Ask your loved ones to help you ensure that your rooms and stairways are clutter-free and well-equipped with lighting, handrails, grab bars, and nonslip mats to help you avoid falling — all of which can go a long way toward keeping you safe in your home. In the event a fall does occur, having a proper Medicare plan can help alleviate surprise medical costs.

Diana Rodriguez also contributed to this report.

Fall-Proofing Your Home | National Institute on Aging

Six out of every 10 falls happen at home, where we spend much of our time and tend to move around without thinking about our safety. There are many changes you can make to your home that will help you avoid falls and ensure your safety.

In Stairways, Hallways, and Pathways

  • Have handrails on both sides of the stairs, and make sure they are tightly fastened. Hold the handrails when you use the stairs, going up or down. If you must carry something while you’re on the stairs, hold it in one hand and use the handrail with the other. Don’t let what you’re carrying block your view of the steps.
  • Make sure there is good lighting with light switches at the top and bottom of stairs and on each end of a long hall. Remember to use the lights!
  • Keep areas where you walk tidy. Don’t leave books, papers, clothes, and shoes on the floor or stairs.
  • Check that all carpets are fixed firmly to the floor so they won’t slip. Put no-slip strips on tile and wooden floors. You can buy these strips at the hardware store.
  • Don’t use throw rugs or small area rugs.

In Bathrooms and Powder Rooms

  • Mount grab bars near toilets and on both the inside and outside of your tub and shower.
  • Place non-skid mats, strips, or carpet on all surfaces that may get wet.
  • Remember to turn on night lights.

In Your Bedroom

  • Put night lights and light switches close to your bed.
  • Keep a flashlight by your bed in case the power is out and you need to get up.
  • Keep your telephone near your bed.

In Other Living Areas

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

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

Your Own Medical Alarm

If you’re concerned about falling, think about getting an emergency response system. If you fall or need emergency help, you push a button on a special necklace or bracelet to alert 911. There is a fee for this service, and it is not usually covered by insurance.

Home Improvements Prevent Falls

Many State and local governments have education and/or home modification programs to help older people prevent falls. Check with your local health department, or local Area Agency on Aging to see if there is a program near you.

Read more about falls and falls prevention. 

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

For More Information About Falls and Falls Prevention

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

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

Content reviewed:
May 15, 2017

Fall prevention: Simple tips to prevent falls

Fall prevention: Simple tips to prevent falls

Falls put you at risk of serious injury. Prevent falls with these simple fall-prevention measures, from reviewing your medications to hazard-proofing your home.

By Mayo Clinic Staff

Fall prevention may not seem like a lively topic, but it’s important. As you get older, physical changes and health conditions — and sometimes the medications used to treat those conditions — make falls more likely. In fact, falls are a leading cause of injury among older adults. Still, fear of falling doesn’t need to rule your life. Instead, consider six simple fall-prevention strategies.

1. Make an appointment with your doctor

Begin your fall-prevention plan by making an appointment with your doctor. Be prepared to answer questions such as:

  • What medications are you taking? Make a list of your prescription and over-the-counter medications and supplements, or bring them with you to the appointment. Your doctor can review your medications for side effects and interactions that may increase your risk of falling. To help with fall prevention, your doctor may consider weaning you off medications that make you tired or affect your thinking, such as sedatives and some types of antidepressants.
  • Have you fallen before? Write down the details, including when, where and how you fell. Be prepared to discuss instances when you almost fell but were caught by someone or managed to grab hold of something just in time. Details such as these may help your doctor identify specific fall-prevention strategies.
  • Could your health conditions cause a fall? Certain eye and ear disorders may increase your risk of falls. Be prepared to discuss your health conditions and how comfortable you are when you walk — for example, do you feel any dizziness, joint pain, shortness of breath, or numbness in your feet and legs when you walk? Your doctor may evaluate your muscle strength, balance and walking style (gait) as well.

2. Keep moving

Physical activity can go a long way toward fall prevention. With your doctor’s OK, consider activities such as walking, water workouts or tai chi — a gentle exercise that involves slow and graceful dance-like movements. Such activities reduce the risk of falls by improving strength, balance, coordination and flexibility.

If you avoid physical activity because you’re afraid it will make a fall more likely, tell your doctor. He or she may recommend carefully monitored exercise programs or refer you to a physical therapist. The physical therapist can create a custom exercise program aimed at improving your balance, flexibility, muscle strength and gait.

3. Wear sensible shoes

Consider changing your footwear as part of your fall-prevention plan. High heels, floppy slippers and shoes with slick soles can make you slip, stumble and fall. So can walking in your stocking feet. Instead, wear properly fitting, sturdy shoes with nonskid soles. Sensible shoes may also reduce joint pain.

4. Remove home hazards

Take a look around your home. Your living room, kitchen, bedroom, bathroom, hallways and stairways may be filled with hazards. To make your home safer:

  • Remove boxes, newspapers, electrical cords and phone cords from walkways.
  • Move coffee tables, magazine racks and plant stands from high-traffic areas.
  • Secure loose rugs with double-faced tape, tacks or a slip-resistant backing — or remove loose rugs from your home.
  • Repair loose, wooden floorboards and carpeting right away.
  • Store clothing, dishes, food and other necessities within easy reach.
  • Immediately clean spilled liquids, grease or food.
  • Use nonslip mats in your bathtub or shower. Use a bath seat, which allows you to sit while showering.

5. Light up your living space

Keep your home brightly lit to avoid tripping on objects that are hard to see. Also:

  • Place night lights in your bedroom, bathroom and hallways.
  • Place a lamp within reach of your bed for middle-of-the-night needs.
  • Make clear paths to light switches that aren’t near room entrances. Consider trading traditional switches for glow-in-the-dark or illuminated switches.
  • Turn on the lights before going up or down stairs.
  • Store flashlights in easy-to-find places in case of power outages.

6. Use assistive devices

Your doctor might recommend using a cane or walker to keep you steady. Other assistive devices can help, too. For example:

  • Hand rails for both sides of stairways
  • Nonslip treads for bare-wood steps
  • A raised toilet seat or one with armrests
  • Grab bars for the shower or tub
  • A sturdy plastic seat for the shower or tub — plus a hand-held shower nozzle for bathing while sitting down

If necessary, ask your doctor for a referral to an occupational therapist. He or she can help you brainstorm other fall-prevention strategies. Some solutions are easily installed and relatively inexpensive. Others may require professional help or a larger investment. If you’re concerned about the cost, remember that an investment in fall prevention is an investment in your independence.

Oct. 04, 2019

Show references

  1. Kiel DP. Falls in older persons: Risk factors and evaluation. http://www.uptodate.com/home. Accessed Aug. 21, 2016.
  2. Falls in the elderly. Merck Manual Professional Version. http://www.merckmanuals.com/professional/geriatrics/falls-in-the-elderly/falls-in-the-elderly. Accessed Aug. 21, 2016.
  3. Important facts about falls. Centers for Disease Control and Prevention. http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html. Accessed Aug. 21, 2016.
  4. Ferri FF. Falls in the elderly. In: Ferri’s Clinical Advisor 2017. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed Aug. 14, 2016.
  5. AskMayoExpert. Fall prevention. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2016.
  6. Falls and older adults: Fall proofing your home. NIH Senior Health. http://nihseniorhealth.gov/falls/homesafety/01.html. Accessed Aug. 21, 2016.
  7. Takahashi PY (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 31, 2016.

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15 Ways to Reduce Fall Risk and Help Prevent Fall for Seniors

It began as a casual visit. However, the situation could have been far worse. During a get-together with my mother, she tried to stand up from her chair but lost her balance and fell. Concerned, I rushed over to offer what help I could. Fortunately, Mom was perfectly fine. I helped her back to her feet and we both had a good laugh over what had just happened.

Seniors falling is not usually a laughing matter. As we age, falls can become increasingly common and risky for seniors. The World Health Organization (WHO) Global Report on Falls Prevention in Older Age states that “approximately 28-35% of people aged of 65 and over fall each year increasing to 32-42% for those over 70 years of age. The frequency of falls increases with age and frailty level. Approximately 30-50% of people living in long-term care institutions fall each year, and 40% of them experienced recurrent falls.”

What are the Facts About Fall Risk?

The Centers for Disease Control and Prevention paint a grim picture by telling us that “more than one out of four older people falls each year, but less than half tell their doctor. Falling once doubles your chances of falling again.”

And unfortunately, there is more. The WHO report shares even more alarming statistics relating to elderly falls:

  • “Falls lead to 20-30% of mild to severe injuries and are the underlying cause of 10-15% of all emergency department visits. More than 50% of injury-related hospitalizations are among people over 65 years and older. The major underlying causes for fall-related hospital admission are hip fracture, traumatic brain injuries and upper limb injuries.”
  • “The duration of hospital stays due to falls varies; however, it is much longer than other injuries and can range from 4 to 15 days.”
  • “Falls may also result in a post-fall syndrome that includes dependence, loss of autonomy, confusion, immobilization and depression, which will lead to a further restriction in daily activities.”
  • “Falls account for 40% of all injury deaths. Rates vary depending on the country and the studied population. The fall fatality rate for people aged 65 and older in the United States of America is 36.8 per 100,000 population (46.2 for men and 31.1 for women).”
  • “Fatal falls rates increase exponentially with age for both sexes, highest at the age of 85 years and over. Rates of fatal falls among men exceed that of women for all age groups in spite of the fewer occurrences of falls among them. This is attributed to the fact that men suffer from more co-morbid conditions than women of the same age.”

4 Long-Term Consequences of Falls Among Older Adults

There are many possible outcomes from a senior’s fall, including:

  1. Injury. Depending on where and how a senior falls, there is a high risk of injury. A senior’s brittle bones can easily become his or her broken bones.
  2. Reduced Independence. Even the smallest fall can result in uncertainty in the mind of a senior. A senior can put up a brave front and appear to be healthy and robust. He or she may even say that the fall is nothing to worry about. However, there may be a lingering doubt about what he or she is capable of doing. After a fall – or a series of falls – a senior may think twice about heading outside for fear of another fall.
  3. Multiple Falls. A single fall can begin a chain reaction of more falls. These continual falls are often the result of a senior’s lack of confidence. Reduced eyesight can result in a senior reaching for a caregiver’s supportive arm or a handrail but missing their target. While a senior or a family caregiver may dismiss a fall as not being serious, this could be completely wrong. A senior may sustain more serious injuries or even die. Let that single fall serve as a red flag of warning.
  4. Further Family Impact. Falling doesn’t always just affect the senior. It can also affect the senior’s family. Family caregivers may have to rush away from their workplaces following a phone call alerting them of such an accident. Repeated phone calls may result in a complete departure from the office. Excessive chatting on the phone can be deemed unnecessary and a distraction from the job at hand leading to job dismissal. A caregiver may also decide to quit a job to be available for their loved one after a fall and tend to any needs that may arise. Or they may wish to be there to help prevent a fall in the first place.

15 Ways to Reduce Fall Risk and Help Prevent Falls

While you may not be able to always stop a senior from falling, you can take some steps to help reduce the risk. There are many reasons for falls in the elderly, so make sure to look at the whole picture. Use these precautions to take care of your loved one and their home to prevent falls:

  1. Begin with the bathroom. Wet surfaces (on the floor or counters) can be very dangerous. Seniors lack the balance and reaction time needed to avoid a fall. While it may seem easy to step out of a shower, an unsteady senior may slip and come crashing to the floor. To help, provide non-slip mats in the bathtub and shower. Install grab bars in strategic points around the bathroom. Towel bars are not sufficient because they will collapse under someone’s full body weight. Grab bars can be attached inside the shower stall or just above the bathtub to help a senior with lowering or standing up.
  2. Provide a shower seat. Seniors can be far more secure when they are seated when showering.
  3. Replace the shower head with a hand-held nozzle. Seniors can become more confident with showering with a nozzle. The nozzle can be easily turned away in the case of sudden water temperature changes. In addition, it can result in a much more thorough cleaning. Long-hoses are now available, which are far easier to use for someone seated in the shower.
  4. Stairs. Whether inside or outside the senior’s home, stairs can be major concerns. I recall my parent’s first retirement home in Victoria, British Columbia. This was a beautiful two-bedroom condo with a view of the ocean but outside access proved to be too much. I often saw my mother grabbing the handrail and pulling herself up the stairs to get inside. If a senior does have stairs, there are plenty of precautions you can take.
  5. Clear the stairs. Whether it is a few dropped clothes or a grandchild’s toy, anything left on the stairs can become a tripping and falling hazard.
  6. Differentiate between the stairs. Aging eyes may not always be able to separate one step from the next. To help, you could try replacing the carpet on each step to make the steps easier to spot. In the case of bare steps, try painting each step a different color. Other options include adding safety tape or removing carpeting and adding stair treads. All flights of stairs should also have handrails on both sides of the stairs.
  7. Consider a stairlift. These mechanisms can safely take a senior up or down a flight of stairs. The senior will sit in a comfortable chair without having to climb up or down the stairs. A colleague of mine used this with her father. This enabled her and her family to turn the basement into a fully-furnished suite for him and his caregiver.
  8. Shovel snow and chip ice off stairs in the winter. This work can be too much for a senior to handle. So why not delegate the job to a younger family caregiver or hire a neighbor? This task prevents slipping and falling outside the home.
  9. Tighten stair handrails. A loose handrail is of little good to anyone grabbing for it. Secure these handrails both inside and outside the senior’s home.
  10. Tuck away extension cords. Are there any power cords stretched across a senior’s floor? Tape them down or slide them underneath or behind furniture.
  11. Remove excess furniture. A more mobile senior may be able to sidestep a footstool or a coffee table but not all seniors can do this. Remove unneeded furniture to give the senior more room to maneuver and help to create a safer living environment. Also, a deep plush armchair may look comfortable but the senior may become trapped if he or she lacks the body strength necessary to push up and out of the chair.
  12. Get a cane or a walker. A doctor can best advise if the senior will need a mobility aid. This could be a wheelchair, a walker, a cane, or a motorized scooter. As with any mobility aid, make sure that is properly fitted for the best and easiest use. Reducing or eliminating the walker stigma that often exists may be a little more difficult to do. However, seniors may find that using a walker increases their own freedom, independence, and quality of life. Be aware that an occupational therapist needs to train the person to use these properly. For increased convenience, choose a wheelchair, walker, or scooter that can collapse and fit easily in a car’s trunk or back seat. Be mindful of the size of mobility aids. A wheelchair or walker may be too wide to fit through a senior’s doorways. A four-wheeled scooter will be better for outdoor use and will provide more stability. A three-wheeled scooter can be far more maneuverable inside the home.
  13. Evaluate a senior’s footwear. Shoes need to fit well and have non-slip soles. Shoes with Velcro straps can be easier to tighten or loosen. They also remove any risk of tripping over long laces. Do not choose senior’s shoes based on how easily they can be put on and taken off. I’ve heard from at least one person whose father wore loose shoes and she had to buy all new shoes for him.
  14. Install better, brighter lighting. Seniors cannot always see that well in a dark or shadowed room. Better, brighter lighting can help to light the way. On this same subject, assess the location of light switches. These may be out of reach for someone in a wheelchair.
  15. Keep a senior active. Whether through regular walking or light exercising and stretching, an active senior can remain more stable than a sedentary senior. Exercising can help prevent falls by keeping stabilizing muscles strong.

What to Ask the Doctor After an Elderly Person’s Fall?

Family caregivers need to understand that falls in the elderly, whether just once or repeatedly, can be a serious matter. Among the first steps for caregivers is to schedule a doctor’s appointment. Accompany your senior loved one into the examination room. Make sure to share the details of the fall and to ask the doctor questions.

What types of questions should a caregiver ask? Leslie Kernisan, MD MPH outlines her recommended medical checks in her article, “8 Things to Have the Doctor Check After an Aging Person Falls.” Make sure to ask for:

An assessment for an underlying new illness. “Just about any new health problem that makes an older person weak can bring on a fall. Some common ones include:

  • Urinary Tract Infection
  • Dehydration
  • Strokes”

A blood pressure and pulse reading when sitting, and when standing. “This is especially important if you’ve been worried about falls — or near falls — that are associated with light-headedness, or fainting.

If your older relative takes blood pressure medication, you should make sure the doctor confirms that he or she isn’t experiencing a drop in blood pressure when standing. (Note that tamsulosin — brand name Flomax — is a popular prostate medication that also causes drops in blood pressure.)”

Blood tests. “Falls can be worsened by problems with an older person’s blood count or by things like blood sodium getting too high or too low. Generally, a complete blood cell count (CBC) and a check of electrolytes and kidney function (metabolic panel, or “chem-7”) are a good place to start.”

Medications review. “Many older adults are taking medications that increase fall risk. These medications can often be reduced, or even eliminated.”

Gait and balance. “Simple things to do, if gait and balance don’t seem completely fine, are:

  • Address any pain or discomfort if that seems to be a cause of problems. Many older people are reacting to pain in their feet, joints, or back.
  • Consider a physical therapy referral for gait and balance assessment. A physical therapist can often recommend suitable strengthening exercises, and also can help fit the older person for an assistive device (e.g. a walker) if appropriate.”

Vitamin D level. “Studies suggest that treating low vitamin D levels might help reduce falls in older adults. Low vitamin D levels can also contribute to fragile bones.”

Evaluation for underlying heart or neurological conditions. “An older person may be falling because he or she has developed a chronic problem with the heart or blood pressure system or Parkinson’s disease.”

Vision, podiatry, and home safety referrals. “Could your loved one be in need of a vision check, podiatry care, or a home safety evaluation? If you’ve brought an older person in after a fall, it’s a good idea to talk to the doctor about whether these services might help.”

Eyesight’s Impact on Fall Risk for Older Adults

It’s been said that our eyes are the windows to the world. But if those windows are dirty or blocked, we cannot properly see people and things around us. Seniors may experience this happening as they lose their eyesight resulting in in significant problems:

  • Focusing difficulty
  • Poor depth perception
  • Trouble balancing
  • Falling

Fortunately, options exist to correct poor eyesight. These include the following:

  • Properly prescribed glasses can sharpen vision (attach a strap between the earpieces to help keep glasses on the face and to reduce the chance of loss)
  • Surgery may clear up glaucoma, macular degeneration, and cataracts
  • Eye drops or medication may soothe eye dryness, watering/tearing, or itchiness, or remove “floaters” (spots which appear in a senior’s line of sight and impede vision)

Diagnosing the nature and scope of the problem is best done by an optometrist during a complete eye exam. Caregivers may find accompanying the senior into the eye exam may reduce the senior’s anxiety and better allow them to listen to the doctor’s report or ask questions.

Strategies to Support Seniors After a Fall

Preventative measures to help reduce fall risk in seniors is always the first step, but if a fall does happen, supporting seniors who have fallen takes two approaches. A caregiver must provide physical support to help a senior safely stand upright again. A caregiver may also provide emotional support to help a senior regain any lost confidence or composure. Helping a senior up from the floor is the first step. Remember these recommendations:

  1. Calm down. Seeing a senior fall can result in panic or worry. Seniors may mirror these reactions and respond in a similar manner.
  2. Check for injuries. Resulting injuries from a fall can vary from slight bumps and/or bruises to more serious fractured ribs. Cuts and/or blood flow can be conspicuous.
  3. Resist rushing. Family caregivers looking for injuries and seniors trying to stand again should proceed gently. Hurrying the process may result in further damage.
  4. Offer help – but don’t get too close. Extending a hand may seem like the simple reaction. But lifting a senior takes strength, balance, and experience. Even well-meaning caregivers may risk strain and undue harm. Encourage the senior to use a chair to pull him/herself to a standing position.

A Longer-Lasting Problem of Falling

A fall may lead a senior to adapting a “once-bitten, twice-shy” mindset and becoming extremely nervous about even standing up out of bed in the morning. It may take time for the senior to regain his or her personal trust. Physical reactions can be accompanied by emotional problems:

  1. Increased fear. Even with offered help, a senior may become tentative about standing or walking. After falling, a senior may take slower and smaller steps.
  2. Anger. Typically stubborn loved ones may greatly dislike knowing of or having a family caregiver’s help. Losing one’s independence can be a difficult thing to accept. Imagine being unable to do something that you could do previously with great ease.
  3. Depression. They have lost their purpose and may simply give up. Family caregivers may also see their loved one withdraw, become sadder, or show severe mood swings.
  4. Denial. Seniors who have fallen may casually dismiss the problem, refuse to talk about it, or conveniently forget about it entirely.

Addressing the emotional impacts of a fall can prove to be trickier for family caregivers. Try these recommendations:

  1. Recognize the senior’s emotions. A senior who has fallen may become increasingly frightened, confused, and even resistant to talk about the experience. Family caregivers can help them by showing understanding, support, and patience.
  2. Appreciate the risk. Unfortunately, a senior who has fallen is, typically, more likely to fall again. When walking with Dad in his later years, I worried about him stumbling. A support belt – which fit snugly around Dad’s waist – was advised. I was shown how I could grab onto this behind Dad’s back and help to keep him upright. I was not, however, completely confident though that I could safely catch Dad if he tripped, or be able to lower him to the ground, so I kept our walks shorter or borrowed a wheelchair for Dad’s use. If precautions need to be clarified with a loved one, explain why they are necessary for the senior’s safety.
  3. Offer encouragement: A reassuring smile, comforting pat on the back, or positive feedback can greatly help a senior who has fallen. Understanding falling has occurred is simple to understand but accepting falling has happened is a much harder thing to ask for. Respond positively, reassure, and help the senior in any way possible. Remember to work within the senior’s capabilities.

Resources:

CDC and Prevention: Older Adult Falls

Senior & Elderly Care: Caring for your loved one

16 Tips for Reducing Fall Risk for Seniors

 

Article submitted by: Francesca Vogel, Home Care Assistance

Falls can become increasingly common for seniors as they age. The World Health Organization (WHO) Global Report on Falls Prevention in Older Age states that “approximately 28-35% of people aged of 65 and over fall each year increasing to 32-42% for those over 70 years of age.”

Facts About Fall Risk

The Centers for Disease Control and Prevention tells us that “more than one out of four older people falls each year, but less than half tell their doctor. Falling once doubles your chances of falling again.”

The WHO report shares even more alarming statistics relating to falls in the elderly:

  • “Falls lead to 20-30% of mild to severe injuries and are the underlying cause of 10-15% of all emergency department visits.”
  • “The duration of hospital stays due to falls varies; however, it is much longer than other injuries and can range from 4 to 15 days.”
  • “Falls may also result in a post-fall syndrome that includes dependence, loss of autonomy, confusion, immobilization and depression, which will lead to a further restriction in daily activities.”
  • “Falls account for 40% of all injury deaths. Rates vary depending on the country and the studied population.”

16 Strategies to Prevent Falls for Seniors

Use these precautions to take care of your loved one and their home to prevent falls:

  1. Provide non-slip mats in the bathtub and shower.
  2. Install grab bars in strategic points around the bathroom.
  3. Provide a shower seat.
  4. Replace the shower head with a hand-held nozzle.
  5. Install a handrail for any stairs.
  6. Clear the stairs of any tripping hazards.
  7. Differentiate between the stairs by replacing the carpet on each step or painting each step a different color to make them easier to spot.
  8. Consider a stairlift that can safely take a senior up or down a flight of stairs.
  9. Shovel snow and chip ice off stairs in the winter.
  10. Tape extension cords down or slide them underneath or behind furniture.
  11. Remove excess furniture.
  12. Get a cane, walker, or a motorized scooter.
  13. Make sure your loved one’s shoes fit well and have non-slip soles.
  14. Try shoes with Velcro straps to make them easier to tighten or loosen.
  15. Install better, brighter lighting.
  16. Keep a senior active.

Questions to Ask After a Senior Falls?

One of the first steps for caregivers after a loved one falls is to schedule a doctor’s appointment. Share the details of the fall and ask the doctor questions. What questions should you ask? Leslie Kernisan, MD MPH outlines her recommended medical checks in her article, “8 Things to Have the Doctor Check After an Aging Person Falls.” Be sure to ask for:

  1. An assessment for an underlying new illness.
  2. Blood tests.
  3. A review of medications.
  4. A gait and balance review.
  5. Any pain or discomfort to be addressed if that seems to be a cause of problems.
  6. Vitamin D level tests.
  7. An evaluation of underlying heart or neurological conditions.
  8. Vision, podiatry, and home safety referrals.

Starting a conversation about falls with elderly parents can be difficult. But the sooner you have the conversation, the sooner you both can take precautions to reduce their fall risk and avoid a fall in the first place. Contacting Home Safety Services for an at-home falls prevention assessment is a great first step.

Resources

How Caregivers can Reduce Fall Risk for Seniors

Fall Prevention: Taking Care of Yourself and Your Home

How Exercise Can Prevent Falls in Seniors

Center for Disease Control and Prevention: Older Adult Falls

8 Things to Have the Doctor Check After an Aging Person Falls

 

 

Fall Prevention at Home | Interim HealthCare

There are many things you and your family can do to reduce fall risks and prevent falls. Sometimes, however, help from professional caregivers can further reduce fall risks and improve safe, independent living at home.


Interim HealthCare’s 50 years of experience in looking at many different situations and developing recommendations to enhance living safely and independently at home starts with the In-Home Assessment from your local Interim HealthCare office. This is a comprehensive review of the clients’ diseases and conditions, medications, ability to handle essential activities such as moving around, transportation, meal preparation, bathing and grooming. We also assess the clients’ mental well-being and nutritional status. Finally, we provide a written report and, most importantly, recommendations for reducing the risk of falls and promoting safety and independence at home.


Personalized help


Different people have different needs. And, there are often times when a person’s needs change. In most instances, we have the ability to provide a comprehensive range of services either through our own offices or with local partnerships. This makes it easier for the client and provides a continuity of assistance and care.


Supportive services


Sometimes it’s just a little bit of help with the activities of everyday life. Interim brings you or a loved one a menu of helpful solutions to the little challenges that jeopardize safety and independence. Professional caregivers help with things such as meal preparation, light housekeeping, companionship, shopping, bathing and grooming and other important services. Helping with getting around or bathing, for example, can avoid high fall risk situations.


Skilled services


Sometimes fall risks come from situations that require skilled nursing or therapy services. For example, physical strength, balance and walking problems can be addressed with physical therapy at home. Nurses might help with medication management. The physician might order skilled nursing services when there has been a change in a medical condition or medications. A nurse might be needed to teach self-management skills. Many of these services may be paid for by insurance plans or Medicare.










  

Hip fractures can be seriously debilitating. However, a recent study suggests that damaged confidence – not just physical injury – can sometimes be partly responsible for a reduction in mobility.

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10 Fall Prevention Tips for Seniors

We are not made of rubber.

The hard truth is that when we fall, we won’t bounce right back up. According to the World Health Organization, 28-35% of people over the age of 65 will fall each year.

Falls are responsible for 10-15% of visits to the emergency department and for more than 50% of injury-related hospitalizations in people over the age of 65.

A fall in your senior years can often result in hip fractures, traumatic brain injuries or broken arms. These all cause serious, negative impacts to the body. After a fall, most seniors may experience:

  • A decrease in independence
  • Confusion
  • Depression
  • A loss of mobility

Falls can drastically reduce your ability to enjoy your daily activities. The secret to preventing injuries from falls can be split into these 2 categories:

  • Keeping your body healthy
  • Making your environment safer.

Check out these 10 tips to help keep you on your feet and participating in the activities you love:

Keep Your Body Healthy

The National Institute of Aging reports that taking steps to improve your overall health can help to lower your chance of falling.

1. The More You Move, the Less You Fall

Regular exercise that focuses on flexibility, strength training and balance can help keep your muscles strong. You are more likely to have flexible joints, tendons and ligaments. When you stumble, you will be more likely to catch yourself. Exercise also keeps your bones stronger and reduces your risk of osteoporosis.

2. Plan For Strong Bones

You won’t always be able to prevent a fall but you can decrease the effects of the fall by keeping your bones strong. You will want to make sure that your diet includes enough calcium and vitamin D.

Remember that activities like smoking, alcohol use and being at an unhealthy weight can also decrease your bone mass and increase the likelihood of breaking a bone when you fall.

 

3. Monitor Your Medications

The more medications you take, the higher your risk of falling. Medications can include side effects such as dizziness, confusion, sleepiness, weakness or urgency to get to the bathroom. When you take multiple medications, it increases your chance of side effects. Talk to your doctor or pharmacist about any side effects that you notice with your medications.

 

4. Sleep

Have you ever heard the expression “falling asleep on your feet”? Not getting enough sleep means you can be more confused, move slower and less aware of your surroundings. An inadequate amount or quality of sleep can decrease your response time and reflexes. If you are feeling tired and drowsy, get more rest instead or sit down and wait for your mind to clear.

 

5. Don’t Drink and Walk

Drinking alcohol can impact your vision, hearing, balance and awareness of your environment. You can misjudge your step quite easily or not be aware of objects around you. When you combine alcohol use with medications, it increases your risk of falls resulting in serious injuries.

 

Making Your Environment Safer

Most falls are a result of a combination of risk factors. You can’t change some of the risks (like aging!) but you can change a few things in your environment to keep you safer.

6. Wear Sensible, Good Shoes

High heels, loose-fitting shoes and slip-on backless shoes are a major risk factor for falls and a quick problem to fix. High heels shorten your stride and make you more likely to trip.

They might not be the most fashionable shoes to wear but the National Institute on Aging recommends to wear shoes that are non-skid, rubber-soled and with a low heel. Or lace-up shoes with non-skid soles. And don’t you dare go sliding around the floors in your socks!  

7. Get Rid of Household Hazards

Take a critical look around your house and yard. Are there any objects that you have almost tripped on? Or pieces of furniture that are unstable? Piles of clutter that block the entrance? Small rugs are also hazardous. Those all need to go!

The Centers for Disease Control and Prevention states that most falls happen at home. So make home your safe zone by removing clutter and making sure you have lots of light.

 

8. Beware of the Bathroom

Bathrooms are a common place to fall. Wet, slippery surfaces and moving too quickly are a bad combination. Make sure that you have non-slip bath mats both in the shower/tub and outside. Have grab bars professionally installed next to and inside the tub as well as next to the toilet.

 

9. Use Caution on Wet and Icy Surfaces

How many people do you know who have slipped on an ice patch? Pretty much everybody has at one time. Ice is slippery! As we age, slipping on the ice becomes more than a potentially embarrassing situation.

You will want to make sure that your walkways and stairs are free of ice and puddles. Take your time and wear sturdy footwear to prevent slipping. Don’t carry too many things in your hands (groceries or packages) as this can upset your balance and make it difficult to see something in your path.

If you can, stay home during bad weather. Services like Amazon can be an option for groceries or big items to be delivered right to your footstep during winter days.

 

10. Go Slow and Use Help

It is common to feel lightheaded and unsteady when you first stand up. Make it a habit to stand up slowly and take a minute to get your bearings before you start to move.

Using a cane or a walker will also give you something to hold onto when you are moving. This can be especially important when walking outside. Talk to a physical or occupational therapist about which device might be most helpful for you and how to use a walker or cane.

 

Bonus Tip

A fear of falling can cause you to be at a higher risk of falling! Being afraid that you will fall may cause you to cut down on your regular activities. You might be tempted to stay at home and not move around.

When you are active you keep yourself stronger and decrease your risk of falling.

Start small. But get yourself moving. Even a simple exercise like practicing going from sitting to standing every day will lower your risk of falling.

Did you know that Nurse Next Door’s caregivers can accompany you for a regular walk outside? Learn how we can keep you healthier, safer and happier at home?  Call us toll free at !

90,000 Prevention of falls and fractures in the elderly

As part of the implementation of the national project “Demography” and the federal project “Older Generation” in the Bryansk region, employees of the geriatric service of GAUZ “Bryansk Regional Hospital for War Veterans” remind of the recommendations of the Russian Gerontological Research and Clinical Center about such important aspects in the life of elderly and senile people. age, as the correct arrangement of the home and physical education and sports.

Every year thousands of elderly people fall at home. Many of them receive serious injuries, including fractures (most often – of the femoral neck, remote parts of the arms and legs, pelvic bones, vertebrae). Falls often occur due to external causes that are not considered important in the domestic environment, but they can be easily eliminated.

Tips:

  • check the condition of the floor in each room: the floor surface must be even, smooth, but not slippery;
  • Install good lighting at home;
  • it should be convenient for you to move around the house: free the aisles, if necessary, ask someone to rearrange the furniture;
  • Remove rugs that slide easily on the floor, or use double-sided tape or a non-slip backing to secure the carpet to the floor and prevent slipping;
  • check the height of the bed: it should be comfortable for you to get up and sit on it, the top edge of the mattress should not be lower than knee level;
  • all necessary items (glasses, books, newspapers, medicines, drinking water, watches) must lie next to the headboard;
  • install the lamp so that it is easy to turn it on while in bed; roll up wires / cables (for example, from lamps, telephone or extension cords) or fasten to the wall so that there is no possibility of tripping over them;
  • invite a specialist and install the handles inside the bathroom and near the toilet;
  • Use an anti-slip mat or self-adhesive anti-slip tapes on the bathroom or shower floor.

Avoid:

  • independently remove items from the upper shelves and mezzanines;
  • stand on ladders and chairs;
  • to use flip flops as home shoes, they increase the risk of falling and often slip off your feet.

Tips for reducing the risk of falls:

  • Exercise regularly: exercise makes your body stronger and improves coordination;
  • Check with your doctor and ask to see all the medications you are taking, including over-the-counter medications, some of which may cause drowsiness or low concentration.
  • Have your vision checked by an ophthalmologist at least once a year: poor vision increases the risk of falling;
  • try to always get up and up from lying and sitting positions very slowly;
  • If it is hard for you to lace up shoes, it is advisable to sew wide elastic bands instead of laces or make a Velcro fastener.

Additional recommendations:

  • Consider using mobile devices to alert you if you fall and are unable to get up;
  • write down and keep in an accessible place the names and phone numbers of your attending physician, close relatives and friends, at the right time they can prompt important medical information;
  • your loved ones should know where your personal documents are kept.

The problem of falls among the elderly: the main risk factors and the most effective preventive measures – Prevention of diseases – Catalog of articles

Source: the magazine “Chief Doctor”.

The elderly make up a large part of the population and their numbers are increasing. As you age, the risk of falls and, consequently, injury increases. A fall may be the first manifestation of an undiagnosed illness. Preventing falls is important because they can significantly increase mortality and morbidity, bring suffering to the elderly and their families, and impose significant costs on society in hospital admissions and nursing homes.

Every year, falls are reported in 30% of people over 65 years old, and among people over 75 years old, this percentage is even higher. 20-30% of those who fall are injured, which reduces their degree of mobility and independence and increases the risk of premature death. The incidence of falls among older people living in institutions is much higher than among people living in a familiar home environment.

Fall prevention programs can help reduce the number and frequency of falls.The most promising appear to be targeted strategies aimed at changing behaviors and modifying risk factors among those living in the home. Effective results have been obtained with integrated intervention programs that include risk assessment and screening.

The use of physical and pharmacological restraints leads to even more serious injury from falls. The use of complex measures of influence in patients with impaired cognitive functions who are in inpatient conditions after a fall did not give positive results, however, the effectiveness of targeted preventive measures in people with impaired cognitive functions living in specialized care institutions was noted.It appears that fall prevention programs can be cost effective, although further research is needed.

Falls may increase over the next 25-30 years unless concerted action is taken. Health and social care agencies need to work together to prevent falls, which should be a priority as part of an overall strategy for promoting the health of older people.

Effective interventions include the following:

– performing exercises at home as prescribed by specialists, designed to develop dynamic balance and strengthen muscles, as well as walking;

– group exercises based on Tai Chi exercises or to develop dynamic balance and strengthen muscles, as well as to develop safe walking skills;

– visiting elderly people who have had cases of falls at home and making changes to the arrangement of the home;

– study of the composition of drugs taken, especially if their number reaches four or more and, if possible, the exclusion of psychotropic substances.

A fall is generally defined as “an incident in which a person is suddenly on the ground or other low surface, except as a result of a blow, loss of consciousness, sudden paralysis or an epileptic seizure” .

Falls and related injuries among older people represent an important problem for health care providers and social workers in Europe and around the world due to the significant increase in life expectancy of people observed during the 20th century . Falls are the most serious and frequent domestic accidents among the elderly. Falls constitute one of the main reasons for hospitalization or admission to a nursing home, even in the absence of serious injury . The incidence of fall-related injuries is increasing more rapidly than could be explained by an increase in the elderly population of 90,091.

In conducting epidemiological studies on falls and related injuries, scientists have encountered a number of conceptual and methodological difficulties.Most of the fractures of the hip as a result of falls fall into the field of medical attention, but in less serious injuries, people often do not seek medical help. Considering that in most cases falls go unnoticed by physicians , statistical indicators of the frequency of falls among the population are largely based on data recorded retrospectively from the words of the victims themselves and / or their loved ones. Despite these difficulties, a number of generalizing conclusions regarding the frequency of falls can already be found in the scientific literature.

Frequency of falls and their consequences

This section summarizes epidemiological data on populations affected by falls from numerous studies in different countries. Fall-related injury rates vary across countries and parts of Europe , however, the summary below provides an indication of the overall magnitude of the problem and potential risk factors that should assist in the design of any fall prevention program.

Elderly people living at home

30% of people over 65 and 50% over 80 suffer a fall at least once a year .

Seniors who have experienced a single fall are two to three times more likely to fall again during the same year .

Approximately 10% of ambulance calls in the United Kingdom are from people over 65 due to a fall. About 60% of these cases are hospitalized 90,091.

20% to 30% of falls result in injuries that reduce mobility and independence and increase the risk of premature death . Somewhat less often falls requiring medical attention lead to fractures . 90 092 Among people prone to falls, one year after the start of observation, 20% were either in the hospital or in a nursing home with 24-hour care, or died.

Older people are hospitalized for fall-related injuries five times more often than for other injuries .90 092 Falls are the leading cause of injury-related deaths among people aged 65 and over; in half of these cases, the fall occurs at home .

For women over 55 and men over 65, age-specific mortality and hospitalization rates for trauma increase exponentially with age. More than a third of all women experience a bone fracture due to osteoporosis at least once in their lifetime, in most cases after falling . For men, the risk of a bone fracture at some point in their life is about half that for women. Fractures account for over 50% of hospital admissions for serious injury from accidents and 39% of fatal injuries.

Seniors in nursing homes

Approximately 50% of seniors in nursing homes suffer a fall at least once a year , up to 40% fall more often than once a year .

Falls are recorded as one of the justifications in 40% of cases when admitted to nursing homes .

The incidence of falls in nursing homes is 1.5 per person per year .

The incidence of falls may double after relocation of older people and return to baseline after three months .

90,002 Among people aged 85 and over, 20% of fall-related deaths occur in nursing homes 90,091.

Fall fractures

Although the proportion of falls resulting in fractures is small, the absolute number of older people with fractures is significant, placing a heavy burden on health systems.

Approximately 10% of falls result in serious injury , of which 5% are fractures . Fractures in the wrist, spine, hip, humerus and pelvis are most common in old age.

Fractures of the femoral neck account for approximately 25% of all fractures resulting from falls in people living at home .

Among those living in nursing homes, the incidence of hip fractures is higher – up to 81 per 1000 people / year . At least 95% of hip fractures occur as a result of falling .

Approximately half of cases of hip fracture as a result of a fall do not recover the ability to walk, 20% of cases are fatal within six months .

Falls not causing physical injury

In 75% -80% of non-injury falls, people do not seek medical attention .

A common consequence of repeated falls is the so-called post-fall syndrome: a combination of depression, constant fear of falling and other psychological disorders . Even in the absence of trauma, loss of self-confidence, social isolation, disorientation and feelings of loneliness may develop.

A fall that is not accompanied by physical injury, however, can be fatal if the victim is unable to get up on his own and is unable to call for help. If an elderly person lies on the floor for more than 12 hours, bedsores develop, dehydration, hypothermia, pneumonia and death may occur . In almost half of the observed cases, elderly people with repeated falls required assistance at least once to get up, but in only 10% of falls, the victim was forced to lie on the floor for more than one hour.

Risk factors

Further research is needed to develop strategies for preventing falls in the elderly population. It is of utmost importance in this regard to identify the groups most at risk in order to maximize the effectiveness of any proposed preventive measures. Published literature has identified specific risk factors for falls and related injuries. However, direct comparison of research results is difficult due to a number of methodological obstacles, such as the use of different populations, lack of clarity and consistency in definitions, variability in follow-up periods, and the inevitable difficulties associated with collecting information from people retrospectively.In addition, the causal relationship between risk factors and the incidence of falls is complex.

The risk factors for falls can be divided into three categories: internal factors, external factors and the degree of exposure to risk. The following section presents the potential risk factors that fall into each of the categories. However, it should be borne in mind that falls are often due to the dynamic interaction of risks of all categories and that the isolated consideration of the individual risk factors presented below does not take into account the influence of confounding factors (in which the effect of one risk factor in multivariate analysis is explained by the effect of another).

Internal risk factors

A history of falls are associated with an increased risk of .

Age: The incidence of falls increases with age .

Gender: Falls are similar in men and women in younger ages, but women in the very elderly are more likely to fall than men and are much more likely to fracture from falling.

Living alone: ​​May be functional, but injuries and falls can be more severe, especially if the victim is unable to get off the floor.Living alone is also a risk factor for falling frequency, although this effect is in part related to certain characteristics of older-occupied dwellings .

Ethnicity: Research data from the United Kingdom and the United States shows that Indo-European ethnic groups are more prone to falls than Africans, Hispanics, or South Asian groups , However, there is no evidence of ethnic variability within continental Europe. confirmed.

Drug use: Benzodiazepine use in old age is associated with a 44% increased risk of hip fracture and falls out of bed while sleeping . The risk of falls increases significantly with psychotropic drugs, class 1a antiarrhythmics, digoxin, diuretics and sedatives . As the evidence base for the use of drugs in the treatment of chronic diseases expands, the number of drugs prescribed is increasing.A significant increase in the risk of falls when more than four different drugs are administered concurrently, regardless of type, has been demonstrated by all relevant studies with the exception of one . Concurrent use of four or more drugs is also associated with a nine-fold increase in the risk of cognitive impairment and the development of fear of falling .

Health Disorders: Cardiovascular Disorders, Chronic Obstructive Pulmonary Disease, Depression and Arthritis – Each of these conditions is associated with a 32% increased risk . The prevalence of falls increases as the burden of chronic disease increases. . Thyroid dysfunction with excessive release of thyroid hormones, diabetes mellitus and arthritis leading to impaired peripheral sensitivity also increase the risk. The prevalence of cardiovascular falls in the general population is unknown, but dizziness is common in those affected by falls. In this group, there are also frequent cases of depression and urinary incontinence .

Disorders of motor functions and gait: the process of age-related decrease in physical strength and endurance, starting after 30 years (every ten years – by 10%), as well as muscle performance (every ten years – by 30%) gradually leads to such a level of decrease in physical functions when performing the simplest responsibilities of daily life becomes difficult and then impossible. In people with a predominantly sedentary lifestyle in previous years, this condition can occur even before the onset of extreme old age . In conditions of a significant decrease in physical strength, endurance and muscle performance, and, accordingly, deterioration of motor functions, when a person stumbles or slips, he is no longer able to keep from falling. Muscle weakness is a significant risk factor for falls, as are disturbances in gait, balance, or the use of walking aids . Any functional disorders of the lower extremities (decreased muscle strength, orthopedic pathology or sensory disturbances) lead to an increased risk. . Difficulty getting up from a sitting position is also associated with an increased risk of .

Sedentary: People prone to falls tend to be less active and this can inadvertently further develop muscle wasting as a result of insufficient training around already unstable joints. A 14-day decline in daily physical activity due to illness is associated with an increased risk of falling . People with low activity levels fall more often than those with moderate or high activity in a safe environment. However, the level of physical activity is so closely related to the functional state of the muscular apparatus that it is very difficult to determine the separate effects of decreased activity and muscle dysfunctions.

Psychological state – fear of falling: up to 70% of those who had experienced a fall shortly before the survey, and up to 40% of those who did not have this, reported having a fear of falling . Decreased physical and functional activity is associated with anxiety and fear of falling. Up to 50% of people with fear of falling limit or completely stop because of this social and physical activity . A strong relationship was found between fear and a slowdown in walking speed and muscle weakness , by a low level of assessment of the state of one’s health and a decrease in the quality of life . Fear of falling and occurrence of falling cases were predictive signs in relation to each other when observed during the year . Women with stroke are at risk of falls and fear of falls . Taking four or more drugs at the same time also independently increases the risk of falls . However, older people are often unable to adequately assess their level of risk.

Eating disorders: Low body mass index, indicative of malnutrition, is associated with an increased risk of . Vitamin D deficiency is especially common among the elderly in nursing homes and can cause gait disturbances, muscle weakness, osteomalacia and osteoporosis .

Cognitive impairment: cognitive impairment is clearly associated with an increased risk, even when it is relatively minor (not reaching the level of profound dementia). The Amsterdam Study on Aging demonstrated that impaired short-term memory in people over 75 years of age is an independent risk factor for falls . Among those living in nursing homes, people with diagnosed dementia were twice as likely to fall as those without cognitive impairment, but there were no differences in injury severity between groups. .

Visual impairments: visual acuity, contrast sensitivity, size of visual fields, as well as cataracts, glaucoma and degeneration of the retinal spot – all these factors affect the risk of falls , as well as wearing glasses with bifocal or multifocal lenses . Multifocal lenses interfere with depth perception of space and contrast visual sensitivity, which makes it difficult to detect external obstacles in a timely manner. It is possible that it is more advisable for older people not to use multifocal glasses while walking up the stairs and in unfamiliar surroundings outside the home .

Pathology of the foot: curvatures and bursitis in the big toe, deformities of other toes, ulcers, deformities of the nails, as well as pain in the feet when walking create additional difficulties in maintaining balance and increase the risk of falls . The nature of the shoe also matters.

External risk factors

The extent to which environmental factors influence the risk of falls in older adults is uncertain.Some studies have shown that 30% to 50% of falls in older people living at home are due to environmental factors, while others have shown that 20% of falls are due to intense external factors (which would lead to a fall in any healthy adult) Elderly people often slip and stumble and find it difficult to maintain balance to avoid falling. The following external factors are distinguished:

1) environmental defects (poor lighting, slippery and uneven floors, etc.)n.) ;

2) the nature of footwear and clothing ;

3) unsuitable walking aids and aids .

Degree of exposure to risk

In some studies, a U-shaped relationship has been identified, that is, the most and least active people are subject to the maximum risk of falls . This demonstrates the complex nature of the relationship between falls, activity level and risk.The nature and intensity of the impact of environmental factors, determined by the lifestyle of an elderly person, interact with internal risk factors. One study found that walking itself increases the risk of falls , others indicate that increased physical activity, on the contrary, reduces the risk of falls, but increases the risk of serious injury . Still, in general, maintaining a moderate to high enough level of physical activity with the use of walking aids appears to have a beneficial effect on the elderly living in nursing homes .

In some situations, physical activity increases the risk of falls due to either greater exposure to adverse environmental factors (slippery or uneven floors, areas with a pile of various objects that need to be repaired sidewalks), or fatigue, or non-compliance with precautions when performing exercises .

Conclusions on risk factors

Since all of the above studies, evaluating a large number of factors, are predominantly exploitative in nature, identifying the determining risk factors in relation to falls seems to be very difficult.However, there is reason to believe that internal factors , are of greater importance for people aged 80 and over, since in this group, loss of consciousness is more often noted (indicating that the fall is associated with one or another general disease). Falls among people under 75 years of age are likely to be more related to external risk factors. A number of studies have shown that the likelihood of falls among older people living both at home and in nursing homes increases exponentially as the number of exposure risk factors increases . The model proposed by Robbins , considers only three risk factors (instability in the hip joint, imbalance and concurrent administration of more than four drugs). In people not exposed to any of these factors, the risk was 12%; in the presence of all three factors, the risk reached 100%.

It would be wrong to conclude that the risk factors that exist for a particular group of people in a given setting are exactly the same as for another group of people in identical or different conditions.For example, in a study by Lord , , it was shown that people living in nursing homes are exposed to different risk factors for falling, depending on whether they can stand without assistive devices or assistance. It is concluded that the highest priority group for falls prevention measures are those who can stand on their own but are exposed to multiple risk factors .

Prevention of falls and injuries

As a result of many years of research, a large amount of epidemiological data has been accumulated to help determine the specific causes and risk factors associated with falls.Based on the identified risk factors, various diagnostic methods have been developed. However, it was only ten years ago that the first attempts were made to test in practice the effectiveness of measures to prevent falls.

A series of multivariate studies on fall prevention among older people living at home have shown that five to 25 people need to be covered to prevent one fall , , which compares favorably with many medical screening programs.There is evidence that slightly different interventions are effective for nursing home residents . Despite the widespread use of fall prevention programs among inpatients, there have been no adequate randomized controlled trials (RCTs).

The review by Feder , contains the following findings:

1) priority should be given to comprehensive measures, including stimulation of physical activity, training and adaptation of the home;

2) it is necessary to use targeted measures to maintain physical activity among people over 80 years old;

3) assessment of housing conditions without referral for assistance and without specific preventive measures is not effective;

4) it is necessary to assess the economic efficiency of complex measures;

Key Findings of the Cochrane Database Systematic Review on Fall Prevention:

1) The most effective prevention of falls can be achieved by addressing multiple risk factors in individual patients;

2) it is recommended that medical care services carry out preventive examinations of elderly people at risk, followed by targeted interventions to control detected violations;

3) maintaining physical activity at home, exercises according to the Tai Chi system, eliminating unfavorable factors in the arrangement of the home for people who have experienced falls, withdrawal of psychotropic drugs and coverage with comprehensive preventive programs – all these are most likely effective measures to prevent falls, their results are associated with values ​​of the total relative risk from 0.34 to 0.80;

4) The effectiveness of measures such as group exercise, supplementation, pharmacotherapy, home improvement for fall survivors, and fall prevention measures for nursing homes is unknown.

The most compelling evidence for the effectiveness of falls prevention comes from those prevention programs that target selected high-risk groups and use multiple interventions combined with a personalized approach . Among the specific measures, the revision of the list of prescribed drugs, as well as the detection and treatment of orthostatic hypotension, turned out to be effective. The effect of the ongoing therapeutic interventions for the tendency to fainting and carotid sinus syndrome has also been demonstrated, although these disorders are not among the typical causes of falls . The data in favor of the measures taken in isolation of the housing environment are still unconvincing . There is now solid scientific evidence that stimulation of physical activity is effective as part of a comprehensive fall prevention program. The data on the isolated use of this measure are less clear , so some studies have shown no effect or very little effect of exercise on the risk of falls despite having a positive effect on a number of known risk factors, such as physical strength.The greatest effectiveness among the most diverse age groups, including people with varying degrees of functional limitations (from mild to very pronounced), are those programs where balance training takes the central place among physical exercises.

Exercise-only programs have primarily targeted older people living at home. Group exercises on the Tai Chi system in a modified version turned out to be effective in prophylactic terms among people over 65 years old with reduced physical strength and imbalance . Similar activities with physically impaired people aged 70 years and older over a 48-week observation period did not bring the desired effect in terms of preventing falls . A 15-week group exercise program for people over 70 was found to be more effective in reducing the risk of falls than eye and home safety screenings . The same authors were able to obtain even more demonstrative results in their next study – with a one-year program duration of . In another study, it was shown that in persons over 65 years of age with a decrease in muscle strength in the lower limbs, imbalance and delayed response participation in a one-year program of group and individual home exercise, the frequency of falls decreased by 40% compared with the control group . Likewise, a nine-month program of group and home exercise to train balance and increase muscle strength in people over 65 years of age with frequent falls resulted in a reduction in fall . Older adults may be expected to be less accurate in their prescribed home exercise than in group exercises, but a study of a home exercise program, partly instructor-led, showed that it was highly effective in preventing falls. At the same time, the maximum economic efficiency was achieved in the group of people over 80 years old .

There are some concerns about the appropriateness of increased physical activity and exercise for elderly people with balance disorders.In one study that recommended walking in the streets as a preventive measure for a group of older people prone to falls, it actually showed an increased risk of injury compared to a control group of . In all likelihood, before embarking on exercises that require good balance, you should first conduct preparatory work to increase strength and flexibility; its duration should be sufficient both to achieve the desired physiological changes and to increase a sense of self-confidence .

A growing body of data is emerging on programs in care facilities for the elderly. Among them, exercise, balance training and environmental improvement are central. Adequate training of personnel leads to a positive effect only in combination with other measures . A recent RCT showed a reduction in the incidence of falls in the elderly group receiving vitamin D and calcium supplements compared with the control group . No convincing data have yet been obtained for prevention programs for patients in hospital settings.

The strategic approach to preventing falls and fractures involves the following three steps:

1) identification of high-risk groups among the elderly;

2) detailed examination of people in these groups to identify individual risk factors for falls and fractures;

3) taking measures to reduce the identified risk factors .

Conclusions

The costs of falls and their aftermath are likely to remain one of the leading health care expenditures in all European countries for the foreseeable future. Close collaboration of health and social services, nongovernmental organizations and other official and community structures is needed to address this critical problem for older people and to provide effective care.

There are still some information gaps and unresolved questions regarding the possibility of transferring the experience of the pilot programs to other countries and social settings. Nevertheless, the main conclusion that follows from the work reviewed in this review is that targeted comprehensive programs are more effective than isolated measures aimed at only one of the risk factors. Strategies to reduce the overall risk for the entire population may be less costly, but targeting people at highest risk appears to be more effective; both approaches should be pursued in parallel.The list of measures with proven effectiveness includes exercises for training balance and increasing muscle strength, correcting the living environment for people who have experienced falls, revising the list of drugs taken with a large number of them and the presence of psychotropic drugs among them. Restraint measures are ineffective and can cause more serious injury. More research is needed to develop the most effective interventions for the elderly with cognitive impairment.

This publication is based on the WHO European Office report “Falls in the elderly: what are the main risk factors and the most effective preventive measures?”.The report reflects evidence-based statements compiled from published systematic reviews of the scientific literature , general reviews , as well as the most important original publications in English. Its main purpose is to highlight key issues of importance to health care providers.

Source: magazine “Chief Physician” 2017/07

Other articles on the topic

Prevention of injuries in the elderly.

Injury is a serious threat to the health and life of people of all ages.Every year, millions of people around the world are injured, disabled, and deprived of their lives because of personal carelessness and negligence or through someone’s criminal negligence and irresponsibility.

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

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

External reasons are associated with improper organization of safe movement, low safety at home, uncomfortable shoes, lack of aids to mobility (canes, 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 great in people who are few (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, and those 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.

Treating the consequences of serious injuries sustained in 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 have depression, thoughts of suicide.

During such a period, it is especially important to pay attention and care for the victim, his family 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.
  • Eyesight and hearing should be checked periodically in order to order stronger glasses or hearing aids in time.
  • Performing home balance and muscle-building exercises as directed by your doctor, and walking every day.
  • Maintaining the optimal temperature in the living room, since significant changes in it 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 shoes. 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, avoid sudden movements.
  • Injury can often be obtained during washing, bathing, so relatives or service personnel should take water to 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 in older people 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.

90,000 Interventions based on individual assessment of the risk of falls and multi-component interventions for the prevention of falls in older people in the community

Review Question

Assess whether fall prevention strategies targeting two or more risk factors (multifactorial interventions) or fixed combinations of interventions (multicomponent interventions) are effective in preventing falls in older people living at home (in a community setting).

Relevance

With age, the likelihood of falling people increases. Although most fall-related injuries are minor, they can cause noticeable pain and discomfort, affect a person’s confidence, and lead to a loss of independence. Some falls can lead to serious, long-term health problems. A combination of factors such as muscle weakness, joint stiffness, hearing problems, vision changes, drug side effects, fatigue or confusion increase the risk of falls as we age.Poor lighting, slippery or uneven surfaces, and poor footwear can also increase the risk of falls.

Various interventions have been developed to prevent falls in older people. These can include single interventions, such as exercise to increase muscle strength, or a combination of interventions, such as exercise and medication adjustments. A combination of two or more components can be presented as a multifactorial intervention based on an assessment of risk factors, or a multicomponent intervention in which all participants receive the same combination of interventions.

Search date

We searched the healthcare literature for randomized controlled trials up to 12 June 2017.

Characteristics of research

We included 62 randomized trials with 19,935 older adults. In most trials, there were more women than men; the average age of the participants ranged from 62 to 85 years. In trials, interventions were compared with an inactive control group receiving routine care / care (no change in routine activities), or the level of attention required (eg, visits) was compared with an active control group receiving an exercise program.

Key Outcomes

We found 43 trials that compared multifactorial interventions with inactive controls. Multivariate interventions resulted in some reduction in falls in people compared to inactive controls, but the quality of the evidence was low because of the large differences in study design. Differences in the number of people who experienced one or more falls, fell repeatedly, suffered a fracture as a result of a fall, or required hospitalization or medical attention, were absent or insignificant.Multifactorial interventions may have little effect on health-related quality of life. The evidence for the adverse events associated with the intervention was extremely limited; in all 12 cases, complaints of problems from the musculoskeletal system, such as back pain, were minor.

We did not find sufficient evidence to evaluate the effect of multivariate interventions versus exercise, as only one small study looked at this.

We found 18 trials evaluating the impact of multiple interventions. Seventeen trials compared the intervention with an inactive control group and five compared it with exercise. In seventeen trials, the intervention included exercise and another component, often training in fall prevention and home safety assessment. The evidence for adverse events associated with the intervention was limited; all six events noted were minor.

Multiple interventions likely reduced the incidence of falls and the number of falls compared to an inactive control group. They can also reduce the number of people falling repeatedly. There was insufficient evidence to assess the effect on falls-related fractures or hospitalizations. Multiple interventions may have little or no effect on the risk of falling requiring medical attention. However, they may have slightly improved health-related quality of life.

Trials comparing multicomponent interventions with exercise showed no difference or slight differences in the frequency of falls and the number of falls. There was insufficient evidence to assess the effect on hospitalization. No other fall outcomes were reported.

Quality of evidence

We rated the quality of the available evidence as low or very low. This means that we have limited confidence in low-quality evidence, but none at all in very low-quality evidence.

Prevention – FALLING PATIENT®

Risk factors

Measures

Disorders of heart rhythm and conduction that can cause falls

Consultation with a cardiologist to determine the correction strategy (drug treatment, installation of artificial pacemakers, etc.)

Hemodynamically significant stenosis of the carotid artery

Consultation of a cardiovascular surgeon to resolve the issue of surgical treatment

Severe aortic valve stenosis

Consultation with a cardiac surgeon to resolve the issue of surgical treatment

Chronic heart failure

Treat heart failure according to clinical guidelines to achieve stable compensation.

If necessary – consultation with a cardiologist.

Arterial hypertension

In patients without senile asthenia

  • Achievement and maintenance of the target SBP 130-140 mm Hg.

  • Do not lower SBP less than 130 mm Hg.

  • Avoid prescribing 3 or more antihypertensive drugs

  • Control for orthostatic hypotension

For patients with senile asthenia:

  • Consultation with a geriatrician to determine the target SBP

  • Do not lower SBP less than 130 mm Hg.Art.

  • Avoid prescribing 3 or more antihypertensive drugs

  • Control for orthostatic hypotension

  • Consider the possibility of reducing the intensity of antihypertensive therapy if the geriatric status worsens

Orthostatic hypotension

  • Revision of medicinal prescriptions to assess the medicinal causes of orthostatic hypotension, including those associated with antihypertensive therapy

  • Correction of medicinal prescriptions

  • Teaching the patient to physical counter-maneuvers and how to safely transition to an upright position

Diabetes mellitus

  • Avoid lowering HbA1c less than 7%

  • Consultation of an endocrinologist if treatment correction is necessary

Low body mass index, malnutrition

Nutritional Support and Weight Recovery Consultation

Imbalance

  • Exercise for balance training

  • Neurologist’s consultation

Anemia

Correction of anemia

Vertigo

Neurologist’s consultation

Mild cognitive impairment

Cognitive Training

Moderate cognitive impairment

  • Cognitive Training

  • Consultation with a geriatrician, neurologist, psychiatrist to resolve the issue of antidement therapy and joint observation

Dementia

Consultation with a neurologist, psychiatrist

Depression

Consultation with a neurologist, psychiatrist

Fear of falling

Psychological consultation

Musculoskeletal pain

  • Treatment of pain syndrome (seefurther)

  • If necessary – consultation with a neurologist, orthopedic traumatologist

Gait disorders

Consultation with a neurologist, orthopedic traumatologist for clinical assessment of gait and determination of specific methods for correcting disorders

Foot problems

  • Correction of violations according to these clinical guidelines.

  • If necessary – consultation with a traumatologist-orthopedist, podiatrist

Peripheral neuropathy

Neurologist’s consultation

Urinary incontinence

Urology consultation

Sleep disorders

  • Non-pharmacological measures for correcting sleep

  • If necessary – somnologist consultation

Sleep apnea syndrome

  • Referral to polysomnography

  • Consultation of a sleep doctor for the selection of a correction method

Use of assistive devices

Careful selection of aids

A program to prevent falls in the elderly starts in Russia – Rossiyskaya Gazeta

A program to prevent falls in the elderly starts in Russia

Every year, 646 thousand people die as a result of falls worldwide, mostly elderly people.Meanwhile, simple household measures plus the necessary medical care reduce the risk of falls many times over. That is why in our country, within the framework of the “Older Generation” federal project, gerontologists have developed a program for the prevention of falls and fractures in people over 65 years of age.

“Pilots” will begin this year in Belgorod, Volgograd, Voronezh, Samara, Kaluga regions, Perm Territory and the Republic of Bashkortostan. And by 2024, the program should work across the country. Its implementation, according to experts, will help improve the quality of life of senior citizens and save up to 30 thousand lives a year.The director of the Russian Gerontological Research and Clinical Center of the Russian National Research Medical University named after V.I. N.I. Pirogova (RGNKTS), chief freelance geriatrician of the Ministry of Health of Russia, Professor Olga Tkacheva and Deputy Director of RGNKTS for scientific work, curator of the program Professor Yulia Kotovskaya.

“Unfortunately, falls are a very common phenomenon. Every second person over 65 has ever fallen, every second of this number has fallen again. And we are talking about falls without external apparent reasons,” explained Olga Tkacheva.-In 15 percent of cases, a fall has serious consequences, leading to disability, inability to care for oneself, that is, complete dependence, and often death. That is why it is so important to prevent falls. “

Who is at risk

Age threshold, according to geriatricians, is 65 years. With age, a person accumulates many diseases that provoke imbalance, muscle strength decreases. For a young and flexible person, an accidental fall most often ends well, but at an older age, falling is extremely dangerous, often fatal.

We treat falls as inevitable: they say, well, what can you do if both muscle strength and coordination of movements are not the same … But experts insist: falls are a medical and largely social problem, since the environment – from the arrangement of everyday life in the apartment to the urban environment – often not adapted to the needs and capabilities of the elderly. And this is wrong.

What Can Be Done

“First and foremost, we need to change the way that falls are unpredictable.We must understand that this does not happen by chance, and it can be prevented, “says Olga Tkacheva. to introduce an assessment of the individual risk of falling and take it into account in treatment. “It is not difficult to do, there are appropriate tests, you just need to introduce them into compulsory practice,” says Professor Tkacheva.

And then it will become clear what should be the approach to the patient: does he need to be accompanied on a walk, perhaps he will need a cane or a walker. Even medication for these patients needs to be carefully selected, as there are drugs that increase the risk of falls.

Second point: medical and social institutions have to be re-equipped – we need reliable furniture, handrails on the walls, “anti-slip” floors.

Third – on the basis of the “Ambulance”, together with gerontological centers and trauma departments, it is necessary to create services for responding to falls of the elderly.The fact is that in case of a hip fracture, surgery should be done as quickly as possible. Otherwise, the patient remains bedridden. The purpose of creating a response service is that if an accident has already happened, the elderly person should receive help immediately.

Children, take care of the parents

Much depends on how the elderly person’s life is arranged. “Falls are possible not only in a hospital,” says Yulia Kotovskaya. “He can fall both at home and on the street.Therefore, creating a safe environment is extremely important. Taking care of this, making the reconstruction of the apartment where the elderly person lives is the concern of his family and children. ”

Adequate lighting is needed, and if the elderly person gets up regularly at night – a night light and the ability to easily turn on the light to the toilet.

Non-slip floor – this is especially true for the bathroom and toilet.By the way, it is better to replace a bathtub with high sides with a comfortable shower stall. that an older person can lean on.

Smooth surface. If there are thresholds, it is better to remove them, as well as carpets (or fix their edges so as not to trip over). Check for wires that interfere with walking around the apartment.

Comfortable home shoes. Flip-flops are easy to put on and take off, but from a safety point of view, they are not the best shoes. We need slippers or house shoes that would “hold” the foot, with a sturdy heel counter.

In many cases, a cane helps. An even more convenient device that protects against falls when walking is a walker on wheels.In Europe, America, people calmly walk the streets with them. So far, unfortunately, we rarely find them where.

Senility can be pushed aside

Experts call this condition differently – senile asthenia and sarcopenia. It is necessary to begin to fight against its onset, as well as to engage in the prevention of osteoporosis (it is because of it that a fall in an elderly person often ends in a fracture) long before a person feels a deterioration in physical condition. And here there is only one secret – physical activity and proper nutrition.

“In geriatric departments it is obligatory to carry out physiotherapy exercises and balance trainings,” notes Olga Tkacheva. “But, of course, you need to start doing such prevention long before the onset of old age. The sooner, the better.”

Professor Julia Kotovskaya recommends adding simple exercises to your daily exercise to train balance, strengthen the muscles and ligaments of the legs and feet. In the WHO recommendations, oriental practices are called: gymnastics such as qigong, tai chi is very suitable for the elderly, since it does not require much physical effort, but it perfectly strengthens muscles and trains the ability to maintain balance.

How to eat right

For the elderly, it is important to have enough calcium in food and vitamin D, the deficiency of which in our northern country is observed in the majority of the population, notes Yulia Kotovskaya. Therefore, calcium-rich dairy products are a must.

Protein is a must. The norm for an elderly person is 1-1.5 grams of protein per 1 kg of body weight. The elderly often do not want meat, and they begin to lean on carbohydrates – rolls, white bread, pasta. It is not right. If you don’t want meat – let it be chicken, fish.Protein can also be obtained from legumes – beans, lentils. Well, of course, good sources of protein are eggs, cottage cheese, cheese and other dairy products.

Salt-free diets may not be safe. “You need to accustom yourself to a small amount of salt from a young age,” Professor Kotovskaya explained. “And in the elderly, we recommend limiting it only in extreme cases, when we see that the patient is very abusing salt. But it is really better to refuse sugar and rolls.”

It is important to drink enough fluids.A day, taking into account liquid food (soups, milk, etc.), should be about 1.8 liters. Of these, 700-800 milliliters of water or unsweetened drinks.

Infographics “RG” / Alexander Chistov / Irina Nevinnaya

90,000 70 percent of hip fractures occur at home

Only urgent surgery can save the lives of older people with this injury

Femoral fracture rate
extremely high all over the world.
Photo by Pixabay

In an environment where all health care forces are focused on the fight against coronavirus, hospitalization for other reasons has become a big problem. Nevertheless, if it is a vascular catastrophe (heart attack, stroke), perforation, serious injury, they try, as far as possible, to immediately take the patient to the hospital and provide assistance, including surgery. In other cases, operations are postponed.

Unfortunately, surgery for hip fractures in elderly patients is also being postponed.Moscow’s chief traumatologist, Professor Vadim Dubrov, recalled the danger of canceling such operations at an online conference. He stated that such surgeries should be carried out immediately for the elderly. To postpone them is to create a threat to life.

The incidence of fractures of the proximal femur is extremely high worldwide. In Russia, according to the Ministry of Health of the Russian Federation, about 125 thousand patients with fractures of the proximal femur are registered annually. And almost 40% of them die in the first year after the fracture.Mortality rates from such fractures have almost equaled those from heart attacks: 46 thousand versus 49 thousand. Unfortunately, only 32 thousand patients out of 125 thousand in need receive surgical care.

The danger increases in older and elderly patients, often suffering from osteoporosis (thinning of bone tissue), which is one of the main risk factors for hip fracture.

Fracture of the proximal femur is the most common injury in people over 60 years of age.Frequent dizziness, unsteadiness of gait, visual impairment, hearing impairment, cognitive deficits, diabetes mellitus and various neurological diseases that progress with age are aggravated by osteoporosis associated with bone aging. The combination of these factors leads to dire consequences.

Surgery within 24–48 hours after injury allows the elderly person to get back on their feet as quickly as possible and return them to their previous level of activity.This “gold standard” is included in clinical guidelines for physicians in Russia.

“Implementation of the optimal assistance program leads to a decrease in mortality by almost six times, to 12.5%. We will not find other specialties where it would be possible to reduce mortality in this way, ”Professor Dubrov emphasized. About 70% of elderly patients with hip fractures will die if they are not operated on and properly treated. This also applies to the situation with the COVID-19 pandemic, in which it is possible and necessary to operate.

Emergency surgery is good. But it is better to avoid a hip fracture altogether. The Russian Gerontological Research and Clinical Center appealed to older and elderly people with a request to be careful during self-isolation and adhere to the rules of organizing a safe life, since a home regime does not guarantee the absence of injuries. After all, 70% of femur fractures in the elderly occur at home.

Specialists of the Russian Gerontological Research and Clinical Center of the N.