Falls are amongst the leading cause of injuries in people older than 65 years of age. Injuries associated with falling result in nearly 3 million emergency department visits a year, with 25% of these visits resulting in serious injuries including bone fractures and traumatic brain injuries.
The risk of falling increases with age, and persons with history of falls are at an increased risk of a future fall.
Many medical societies including the American Geriatric Society and Centers for Disease Control and Prevention, have created guidelines on how to assess falling risk. These risks are addressed with your Family Physician, who then determines how to create a safe environment to prevent a future fall or fall related injury.
Risk Factors for falling
There are many risk factors which contribute to falling. The role of your Family Doctor is to review these risk and modify the ones an individual has control over. Sometimes excessive falls can lead to a fear of falling, which potentially impact patients in a negative way. Majority of falls are associated with multiple risk factors, but it takes a team approach to decrease this risk, and should be done under doctor supervision.
Risk factors are placed in two different categories, modifiable and non modifiable.
Modifiable Risk Factors for Falling
1. Chronic diseases: This includes cardiac arrhythmia, congestive heart failure, and hypertension, along with diabetes, low body weight and vitamin D deficiency.
Your Doctor can help determine which medications have a potential to increase fall risk, and adjust the dosages along with educating patients on safety of taking these prescribed meds.
For example, if a patient has uncontrolled cardiac rhythm, then the risk of dizziness and associated falls is increased. Medications may need adjustment to help relieve associated symptoms. Another example would be diabetes, and overmedication to regulate blood sugar levels. This can potentially cause low blood sugar levels which can lead to feeling light headed and increasing the risk of a potential fall.
It is important to discuss how medications play a role in falling risk, and adjust as indicated.
We, At Florida Advanced Medicine, prefer when our patients bring in their prescribed medications along with any supplementations taken to help review the risk of falling associated with medication.
We also have an on-staff pharmacist to assist in medication therapy management when needed.
Out goal is to help patients improve and potentially reverse their chronic conditions by optimizing their lifestyle. This in turn will decrease the risk of falling by limiting the amount of medications required to control their chronic diseases.
2. Musculoskeletal conditions: Poor joint health, foot problems, muscle weakness and usage of assistance devices increase the risk for falls in older persons.
Severe arthritis, especially affecting weight bearing joints, can lead to gait and balance impairment. If this is combined with sensory issues associated with chronic diseases, then the fall risk increases.
Your Family Physician can assess the need for physical therapy, exercise regimen, or supportive devices to help prevent a fall.
It is important to discuss activities of daily living with your physician to truly understand what your capabilities are, and how to create goal driven strategies to improve your overall wellness.
3. Neurological conditions: Patients with altered mental status, dizziness or vertigo, sensory deficits and movement disorders such as Parkinson's disease are at an increased risk of falls.
Medications should be reviewed, and appropriate physical therapy should be recommended to help preserve independence while maintaining safety.
4. Psychological conditions: Depression, delirium, even fear of falling are associated with increased risk of falls.
It is important to discuss these conditions, along with many others that are associated with falls with your primary care physician. Simple modifications to drug regimens, along with physical therapy and exercise regimen is a great approach to decreasing the risk of a potential fall related injury.
Non-Modifiable Risk factor for Falling
Some conditions increase the risk of falling and are often progressive in nature, or unmodifiable. These include age greater than 80, severe arthritis not amenable to surgery, severe dementia, female gender, history of stroke, history of falling, history of bone fractures or deformity, certain races, and recent hospitalizations.
Being aware of potential risk, and maintaining frequent follow up with your primary care physician will allow for you to prepare your environment to decrease the risk of falls. From adjusting medications, to reviewing the safety of your home and supportive devices is important to preserve independence.
Fall Prevention Screening with your Family Doctor
Your primary care physician will screen all age appropriate individuals annually for history of falls, frequency of falls and assess gait abnormalities as recommended by the American Geriatrics Society and British Geriatrics Society.
You should be also assessed for any history of fear of falling. These two screening modalities should be completed at the same time to ensure a thorough evaluation is done every year.
During this evaluation, your blood pressure should be assessed to determine any discrepancies in postural pressures or pulses.
Your Family Physician will also evaluate visual issues, foot care, and review any medical devices which may be associated with increased risk of falling.
It is important to identify group exercise programs in your community to improve strength and balance. If necessary physical therapy referrals are to be made.
It is important to identify home safety modifications such as installations of grab bars in the bathroom and evaluating for tripping hazards such as steps in the home, pets, and flooring inconsistencies.
It is recommended that adults at an increased risk of falls should consider Vitamin D3 Supplementations (Minimum of 800 IU daily). This is to be evaluated by your physician.
Medications Associated with increased risk of falling
The "Beers List" is updated by the American Geriatric Society, and includes evidence based recommendations for healthcare professionals to help improve the safety of their patients by reviewing the prescribed medications in older patient populations.
Some medications are associated with increased risk of falling, which include anticonvulsants, antidepressants, antiparkinsonian drugs, antipsychotics, sedatives such as benzodiazepines and hypnotics, along with pain medications including opiates and non steroidal anti-inflammatory drugs
More commonly, cardiac medications including antihypertensives, diuretics, digoxin along with medications to help you urinate or treat constipation such as a laxative increase the risk of falls.
These will be assessed by your primary care physician and local pharmacist to review potential drug side effects and interactions.
In Conclusion
Falls are the leading cause of fatal and nonfatal injuries in persons older than 65. It is important for patients and their families to assess safety and fall prevention with their primary care physician.
We are eager to help improve the safety and quality of your life at Florida Advanced Medicine.
We look forward to serving our community.
