Preventing falls is an urgent issue, especially for the elderly, because for an older person a fall can be a death sentence.
Falls are the leading cause of accidental death in older people, most often because the fall results in a serious fracture. The various disabilities experienced by older persons can make them highly vulnerable to falls.
In any given year, about one-third of the elderly people living in their own homes and half of those living in institutions will suffer a fall.
The key to prevention is simple: Identify risks and do whatever is necessary to minimize them.
For people living at home, environmental factors are most important--loose rugs, electric cords that sprawl across the floor, ice on the street, broken pavement. Even getting in and out of cars and trains can present a risk.
For people in institutions, personal factors pose more of a risk. Neurological deficits, poor vision, poor hearing, poor balance control, bone or joint abnormalities resulting from conditions such as arthritis. Cardiovascular problems can also increase the risk of a fall.
And for any older person, the risk of a fall can be increased by medications, especially those acting on the central nervous system--sleeping pills, anti-anxiety drugs, antidepressants.
Home risks can be reduced by going methodically through the home and correcting potentially dangerous situations. Electric cords can be put out of the way, throw rugs can be anchored, lighting can be improved, handrails can be installed in dangerous sites, nonskid stickers can be put in the shower and bath.
Medications should be kept to a minimum and monitored carefully when they are prescribed.
Training can help. Older people should learn to give up activities that may no longer be within their ability, such as climbing on ladders and standing on chairs to reach objects in the closet.
Exercise can be useful. In one recent large-scale study, the incidence of falls was reduced by 10% for older people who were enrolled in exercise programs. The reduction was 17% when the program included balance training.
Such exercise programs are not always available, but they can be arranged through family physicians.
Several relatively simple tests can assess the risk for an individual. One is the "get-up-and-go test," in which the person is asked to stand up from a chair without using the hands and walk across the room. It's a good way to assess the strength of the lower extremities.
And asking someone to simply reach up and take an object from a shelf is a test of upper extremity performance.
Help is especially important for someone who already has experienced a fall. Fear of another fall can become crippling, leading to social isolation, inactivity and depression. Intervention--identifying and correcting risk factors--can help an older person lead a more active, satisfying life.