New Guidelines to Reduce the Risk of Falls by Elderly People

The American Geriatrics Society and the British Geriatric Society have updated their guidelines for preventing falls in the elderly; this is the first update since 2001, and there are several important new features to report.

Falls present a common health problem for older adults, and are a common cause of loss of independence. In fact, one of the guidelines panel believes that falls are as serious a health problem for older people as heart attacks and strokes. The update in the guidelines is based on review of medical literature published since 2001, with the emphasis on randomized controlled trials. The panelists found that most effective trials for preventing falls in older people looked at multiple interventions rather than focusing on just one. 

Screening and assessment of an individual’s risk of falling should include these additions to previous screen items (such as gait, balance, frailty, cardiovascular health, and medications):

1.    A history of previous falls

2.    Examination of footwear and feet

3.    Ability to carry out activities of daily living (real and perceived)

4.    Presence of ‘fear-of-falling’ anxiety

Among the 20-odd specific recommendations, the following should be emphasized:

1.    An exercise component for balance, gait, and strength training, is a vital part of management. Tai Chi is particularly beneficial, but physical therapy or other exercise programs can work well.

2.    A healthcare professional that’s specialized in environmental remodeling should be consulted to help reduce factors in the home and in daily activities that increase the fall risk.

3.    Cataract surgery should be done, if indicated.

4.    Medications should be reviewed and reduced or withdrawn if feasible; this is especially important for sedatives, antidepressants, and other drugs affecting the central nervous system. A condition known as cardioinhibitory carotid sinus hypersensitivity can lead to unexplained recurrent falls, and should be treated in a special facility (dual-chamber cardiac pacing).

5.    Those subjects at risk for falls, as well as those with known or suspected vitamin D deficiency, should take a daily vitamin D supplement (800 IU).

Again, a team approach in assessing the risk of falling, as well as in the institution of recommended management steps, must be paramount.