Blog | Tuesday, September 11, 2012

Preventing falls in older patients


Falls are the most common cause of injury in adults 65 years or older. About one third of adults in that age group fall at least once per year, and 5% to 10% of those falls result in a broken bone, a laceration, or a head injury. Injuries sustained due to falls can cause a permanent decrease in mobility and independence.

The harm that results from falls is much harder to treat than to prevent. One way to prevent the harms due to falls is to test for and to treat osteoporosis. Another way is to try to prevent older people from falling in the first place.

In the Annals of Internal Medicine, the U.S. Preventive Services Task Force reviewed the existing evidence about various methods of fall prevention and recommended that all adults aged 65 or older who are at increased risk for falls receive vitamin D supplementation and exercise or physical therapy.

Who is at increased risk of falling? Very simple assessments that are easily done by primary care doctors can identify these patients. Patients with a history of falls, a history of mobility problems, or poor performance on a simple walking test are likely to fall in the future.

The fact that vitamin D supplementation prevents falls in older patients is not new. (I wrote about it two years ago.) The mechanism by which it does this is unclear. Perhaps it helps muscle strength or balance. But it's a simple and harmless intervention. Exercise and physical therapy are also well-established methods to improve balance and mobility and help patients stay on their feet. And of course exercise has lots of other benefits.

A home assessment for fall risks by a geriatric case manager can also be helpful, though the USPSTF did not find enough evidence to recommend this for all older adults. Making sure that loose rugs are either secured or taken away, that stairs are well lit and have rails, and that grab bars are available in bathrooms can help someone with imperfect vision or imperfect gait stay stable.

So if you have a loved one who is stumbling occasionally, make sure her doctor knows. Some vitamin D and some physical therapy may make a big difference.

Learn more:
Scientists Weigh In on Fall Prevention (New York Times)
Prevention of Falls in Community-Dwelling Older Adults: U.S. Preventive Services Task Force Recommendation Statement (Annals of Internal Medicine)
The Most Recent Celebrity Vitamin: D (My post in 2010 summarizing the current evidence about vitamin D supplements)
Tai Chi Improves Balance in Patients with Parkinson's (My post in February about Tai Chi for fall prevention)
The timed Get-Up-and-Go test (The Society of Hospital Medicine)

Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000. Holding privileges at Cedars-Sinai Medical Center, he is also an assistant clinical professor at UCLA's Department of Medicine. This post originally appeared at his blog.