New guidelines on preventing elderly people from falling recommend that exercises like the Chinese martial art tai chi, a reduction in medication and control of low blood pressure should be included in healthcare practices for older patients.
The guidelines from the American Geriatrics Society and the British Geriatrics Society, published in the latest edition of the Journal of the American Geriatrics Society, state that doctors and other health professionals should determine whether their older patients are at risk of falling by asking if they have fallen recently or if they are unsteady walking.
If so, health providers should look for the presence of known problems such as muscle weakness, poor balance or blood pressure that drops too much on standing.
“Falls are one of the most common health problems experienced by older adults and are a common cause of losing functional independence,” said Dr. Mary Tinetti of Yale University School of Medicine, USA, and one of the panel chairs. “Given their frequency and consequences, falls are as serious a health problem for older persons as heart attacks and strokes.”
First recent updates
This is the first time in a decade that updates from the two geriatrics societies have been updated. They now recommend that all interventions for preventing falls should include an exercise component and that a number of new assessments should be used, including; feet and footwear, fear of falling, and ability to carry out daily living activities.
Using analyses, randomised controlled trials, before-and-after studies and cohort studies published between May 2001 and April 2008, a panel, comprising members from previous panels and new member who are experts in fall prevention and care of older patients, drew up the guidelines.
Older patients determined to be at risk of falling are advised to receive the interventions described in the guidelines, but if there is no evidence of gait problems or recurrent falls, they do not require a risk assessment.
Exercise for balance
The new recommendations for interventions focus on multifactorial interventions which include exercise for balance, gait and strength training, such as tai chi or physical therapy; environmental adaptation to reduce fall risk factors in the home and in daily activities; cataract surgery where needed, but the guidelines recommend against vision intervention as an individual approach; and medication reduction, regardless of the number of medications prescribed (in 2001, reduction of medication was only recommended for those on at least four) with particular attention to medications that affect the brain, such as sleeping medications and antidepressants; focus on raising low blood pressure and managing heart rate and rhythm abnormalities.
“We found that the most effective trials for preventing falls in older people looked at multiple interventions rather than just one; previous studies have indicated that it is more effective to focus on one intervention, but because we looked at not only what recommendations were given, but also which carried out, we’re confident that multifactorial interventions is the best course of action,” said Dr. Tinetti.
“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. By making fall prevention part of the clinical care of older adults this trend can continue,” she added.