Guidelines to Prevent Falls in Older Adults Say Exercise, Fewer Meds

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It has been a decade since guidelines to prevent falls in older adults were issued by the American Geriatrics Society and the British Geriatric Society. Now new guidelines say exercise, risk assessments, and fewer meds are among the recommendations clinicians should consider when meeting with older patients.

Tai chi and fall screening can benefit older adults

Each year in the United States, one-third of older adults 65 years and older experiences a fall, and these falls are the leading cause of injury death. The Centers for Disease Control and Prevention notes that 81 percent of fall deaths involved people 65 and older, and that in 2009, the rate of fall injuries for adults 85 and older was nearly four times that for adults ages 65 to 74.

All older adults are not affected by falls in the same way. Men are more likely to die from a fall, and older whites are 2.5 times more likely to die from falls than their black counterparts. Older non-Hispanics have a higher fatal fall rate than do Hispanics. Overall, the death rates from falls among older people have risen significantly over the past ten years.

The updated guidelines, which appear in the latest Journal of the American Geriatrics Society, are an effort to improve these statistics and the lives of older adults who are at great risk of falls and related injuries. A panel of experts compiled the new recommendations, among which clinicians are asked to include fall screening and prevention as part of their healthcare regimen for older adults.

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The guidelines note that practitioners should question their older patients about any recent falls or difficulties with walking. Patients who respond positively should be assessed for contributing factors, such as muscle weakness, balance problems, or orthostatic hypotension (drop in blood pressure when standing) and then provided with recommended interventions.

Among the interventions recommended in the new guidelines are:

  • exercise to improve balance, gait, and strength, such as physical therapy or tai chi
  • a reduction in medication use, as older adults often are taking multiple medications, any one or more of which can affect the brain and physical function
  • management of low blood pressure or heart-related conditions
  • suggested modifications to the patients’ environment to reduce risks of falls in daily life
  • cataract surgery if necessary, on an individual basis

According to Dr. Mary Tinetti of Yale University School of Medicine, one of the panel chairs, “falls are as serious a health problem for older persons as heart attacks and strokes.” More than 90 percent of hip fractures among older adults are caused by falls, and these injuries can result in severe health problems and premature death.

She also pointed out that “There is emerging evidence that the rate of serious fall injuries, such as hip fractures, is decreasing modestly in areas in which fall prevention is integrated into clinical practice.” Therefore the new guidelines to prevent falls in older adults may be just what the doctor ordered.

Sources:
Centers for Disease Control and Prevention
Wiley press release, January 13, 2011

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