How Can We Prevent Falls?

Excerpt

Falls prevention is a public health priority in older people, since falls are one of the main modifiable causes of decreased functioning, emergency department, hospital and nursing home admission, and of death. It is especially true in subjects aged 75 or older, in order to prevent hip fractures.

The latest guidelines urge practitioners to screen older subjects regularly for their risk of falling, by looking for the three main risk factors of falling:

1. Falls and fall-related injuries in the previous year.

2. A feeling of fear of falling.

3. A feeling of unsteadiness when standing or walking.

In the absence of these three factors, subjects are at low risk of falling and a regular physical activity and education can be recommended to maintain balance/gait/muscle strength.

In the presence of one of those three risk factors, or in patients for whom the interview is difficult, complementary assessment should be undertaken, looking for abnormal:

1. Balance: time held on one foot <5 s.

2. Walking: Timed up and go patients test performed in >20 s.

3. Muscle strength: 5 chair-rising strength in >15 s.

Subjects are at high risk of falling in case of:

1. Recurrent or injurious falls, especially after a hip fracture.

2. Balance, walking or muscle strength disorder.

They should be offered an individualised, multifactorial falls and fracture risk assessment and prevention programme.

1. Planned ideally in the setting of a falls clinic.

2. In conjunction with a fracture liaison service for patients who have experienced a fragility fracture, especially a hip fracture.

3. Including:

   1. -

      Assessment and management of conditions that impair:

      1. Balance/gait (including vision optimisation, management of postural dizziness/postural hypotension, progressive withdrawal of falls-related inducing drugs, multifaceted podiatry and measures to improve home safety, managed at best by an occupational therapist)

      2. Muscle strength (including the prescription of vitamin D supplements in case of deficit)

      3. Bone (diagnosis and management of osteoporosis).

      4. or induce fainting (including insertion of a pacemaker in case of carotid sinus hypersensitivity)

   2. -

      Physical activity by a physiotherapist in order to improve balance, ankle flexibility, lower limbs muscle strength and the ability to getting up from the ground.

Other subjects are at moderate risk of falling: fall prevention measures should include education and exercises performed in a community fall prevention programme and management by the GP of conditions that moderately impair balance/gait/muscle strength or induce a feeling of fear of falling or unsteadiness (see above).