What is fall prevention?
About one in three older adults experience a fall each year. Older adults are also more likely to experience fall-related injuries, including fractures, head injury, long-term mobility issues, and reduced independence. Therefore, fall prevention is typically targeted at older adults, and involves person-specific strategies to manage modifiable risk factors. Fall prevention methods can include environmental modifications (e.g., putting railings in the shower), management of any chronic conditions that increase fall risk, and physical training.[1][2] Since falls in older adults are a serious public health problem, organizations like the https://www.cdc.gov/steadi/index.html and the [https://ncoa.org/professionals/health/center-for-healthy-aging/national-falls-prevention-resource-center/falls-free-initiative](National Council of Aging) have developed fall prevention initiatives.
How is the need for fall prevention measured?
Accurately identifying people that need a fall prevention intervention is a challenge.[2] It’s recommended that the risk for falls be determined by asking people whether they’ve fallen in the past, whether they are afraid of falling, or whether they experience gait and/or balance difficulties. People who may be at risk for falls can have their gait and balance measured with the [https://www.cdc.gov/steadi/pdf/TUG_test-print.pdf](Timed Up and Go Test (TUG). Other less-commonly-used assessments include the Berg Balance Scale and the Tinetti Performance-Oriented Mobility Assessment Tool.[1]
How does physical activity affect fall prevention?
Many older adults, especially those with a history or a fear of falling, reduce and restrict their physical activity with the intention to reduce their risk of falls. Unfortunately, this usually results in physical deconditioning and conversely increases the risk of falls.[2] Consequently, most research has linked expert-directed moderated physical activity as a factor that reduces the risk of falls.[2] Meta-analyses of over 10,000 participants show that exercise reduces fall risk by 23% compared to control.[3] [4] Many exercise regimens have been studied, including functional balance training, resistance training, flexibility, patterned movement (Tai Chi/dance), and endurance training. Exercise can help to improve functional stability (e.g. by increasing lower body strength) and balance, providing additional layers of defense against a fall.[3][5]
Have any supplements been studied for fall prevention?
Supplements for fall prevention are usually targeted at managing conditions that increase the risk for fracture or other acute conditions during a fall. For example, vitamin D and calcium have been studied for preventing fall-related injuries, as these nutrients help to stave off osteoporosis.[6] However, some evidence suggests that high-dose vitamin D may actually be associated with an increased risk of falls when compared to lower doses, although it’s not clear why that would be the case.[7][8].
How can diet affect fall prevention?
Dietary interventions have not been directly studied for fall prevention. However, diet can have many indirect effects on fall risk. For example, a nutritionally balanced diet that promotes a healthy weight may help to prevent falls and fall-related injuries in older adults and in people with osteosarcopenic obesity syndrome.[9] Correcting malnutrition, such as inadequate dietary protein and calcium intake, in the elderly may also reduce the risk of falls.[10][11]
Which other factors help prevent falls?
In addition to exercise, other interventions to prevent falls include strategies to avoid hypotension, managing medications that increase the risk of falls, reducing foot and vision problems, and increasing home safety.[6][4] Strategies to reduce the severity of fall-related injuries include osteoporosis management, hip protectors, and digital technology or wearables.[1] Managing environmental factors such as lighting, stair and bath rails, clutter, and weather conditions can also help to prevent falls.[2]
Examine Database: Fall Prevention
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Frequently asked questions
About one in three older adults experience a fall each year. Older adults are also more likely to experience fall-related injuries, including fractures, head injury, long-term mobility issues, and reduced independence. Therefore, fall prevention is typically targeted at older adults, and involves person-specific strategies to manage modifiable risk factors. Fall prevention methods can include environmental modifications (e.g., putting railings in the shower), management of any chronic conditions that increase fall risk, and physical training.[1][2] Since falls in older adults are a serious public health problem, organizations like the https://www.cdc.gov/steadi/index.html and the [https://ncoa.org/professionals/health/center-for-healthy-aging/national-falls-prevention-resource-center/falls-free-initiative](National Council of Aging) have developed fall prevention initiatives.
Most falls in older adults do not result in severe enough injury for medical attention. While only about 3–5% of falls in elderly people result in fractures (hip, ankle, etc.), an additional 5–10% of falls cause other serious injuries requiring medical care, including hematoma, concussions, TBI, joint dislocation, severe laceration, sprain, and other disabling soft tissue injury. A further 30–50% of falls result in a variety of minor soft tissue injuries, and the remainder result in trivial or no injury. The percentage of falls that are severe enough to lead to admissions to acute care hospitals or the emergency room, and to end in serious injury, chronic pain, loss of independence, or even death, is small.[12][15] [16]
Accurately identifying people that need a fall prevention intervention is a challenge.[2] It’s recommended that the risk for falls be determined by asking people whether they’ve fallen in the past, whether they are afraid of falling, or whether they experience gait and/or balance difficulties. People who may be at risk for falls can have their gait and balance measured with the [https://www.cdc.gov/steadi/pdf/TUG_test-print.pdf](Timed Up and Go Test (TUG). Other less-commonly-used assessments include the Berg Balance Scale and the Tinetti Performance-Oriented Mobility Assessment Tool.[1]
Generally, the risk of falling is increased by factors that reduce normal postural stability, such as age-related decline in balance, gait stability, and cognitive and cardiovascular function. Other factors that increase fall risk include acute illness, certain medications (e.g., sedatives, antidepressants, antihypertensives), and environmental factors (e.g., lack of sidewalks, poor lighting). Nonmodifiable factors that are associated with higher fall risk include age, female sex, and a history of falling. Many falls in the elderly are multifactorial, involving a combination of intrinsic factors such as certain medical conditions, abnormalities in gait, reduced balance and physical strength, reduced strength, and problems with the musculoskeletal system. In the younger population, factors that increase fall risk mostly involve unsafe environments and high risk activities (e.g., climbing, mountain biking, skateboarding).[12]
The risk of falls increases with chronic conditions that involve pain, balance problems, muscle weakness, and cognitive impairment. For example, osteoarthritis and neuropathy increase the risk for falls usually due to increased pain and mobility limitations, secondary to these conditions. Parkinson’s disease and stroke are associated with gait impairments which can make a person more susceptible to falling. Dizziness can worsen balance and may be caused by medications for hypertension or by orthostatic hypotension. Conditions such as cataracts and macular degeneration cause visual impairment and can increase the risk of stepping on hazards or mis-stepping. Depression has been frequently associated with greater fall risk, although the mechanism is not clear.[13] [14]
Many older adults, especially those with a history or a fear of falling, reduce and restrict their physical activity with the intention to reduce their risk of falls. Unfortunately, this usually results in physical deconditioning and conversely increases the risk of falls.[2] Consequently, most research has linked expert-directed moderated physical activity as a factor that reduces the risk of falls.[2] Meta-analyses of over 10,000 participants show that exercise reduces fall risk by 23% compared to control.[3] [4] Many exercise regimens have been studied, including functional balance training, resistance training, flexibility, patterned movement (Tai Chi/dance), and endurance training. Exercise can help to improve functional stability (e.g. by increasing lower body strength) and balance, providing additional layers of defense against a fall.[3][5]
Supplements for fall prevention are usually targeted at managing conditions that increase the risk for fracture or other acute conditions during a fall. For example, vitamin D and calcium have been studied for preventing fall-related injuries, as these nutrients help to stave off osteoporosis.[6] However, some evidence suggests that high-dose vitamin D may actually be associated with an increased risk of falls when compared to lower doses, although it’s not clear why that would be the case.[7][8].
Dietary interventions have not been directly studied for fall prevention. However, diet can have many indirect effects on fall risk. For example, a nutritionally balanced diet that promotes a healthy weight may help to prevent falls and fall-related injuries in older adults and in people with osteosarcopenic obesity syndrome.[9] Correcting malnutrition, such as inadequate dietary protein and calcium intake, in the elderly may also reduce the risk of falls.[10][11]
In addition to exercise, other interventions to prevent falls include strategies to avoid hypotension, managing medications that increase the risk of falls, reducing foot and vision problems, and increasing home safety.[6][4] Strategies to reduce the severity of fall-related injuries include osteoporosis management, hip protectors, and digital technology or wearables.[1] Managing environmental factors such as lighting, stair and bath rails, clutter, and weather conditions can also help to prevent falls.[2]
References
Examine Database References
- Fall Risk - Broe KE, Chen TC, Weinberg J, Bischoff-Ferrari HA, Holick MF, Kiel DPA higher dose of vitamin d reduces the risk of falls in nursing home residents: a randomized, multiple-dose studyJ Am Geriatr Soc.(2007 Feb)
- Fall Risk - Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R, Wong JB, Egli A, Kiel DP, Henschkowski JFall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trialsBMJ.(2009 Oct 1)
- Fall Risk - Michos ED, Kalyani RR, Blackford AL, Sternberg AL, Mitchell CM, Juraschek SP, Schrack JA, Wanigatunga AA, Roth DL, Christenson RH, Miller ER, Appel LJThe Relationship of Falls With Achieved 25-Hydroxyvitamin D Levels From Vitamin D Supplementation: The STURDY Trial.J Endocr Soc.(2022-Jun-01)
- Functionality in Elderly or Injured - Guralnik JM, Sternberg AL, Mitchell CM, Blackford AL, Schrack J, Wanigatunga AA, Michos E, Juraschek SP, Szanton S, Kalyani R, Cai Y, Appel LJ,Effects of Vitamin D on Physical Function: Results From the STURDY Trial.J Gerontol A Biol Sci Med Sci.(2022-Aug-12)