Almost 30% of persons over 65 years of age fall each year. In those over age 80, 50% fall. Almost 5% who fall, fracture; 1% sustain a hip fracture. (N Engl J Med 1994;33:872-873.)
It is critical to evaluate the circumstances and mechanisms of falls.
American Bone Health works with the National Association of Chronic Disease Directors and the National Falls Coalition to raise awareness of falls prevention.
Studies suggest that a 50% reduction in fractures could be achieved by a fall prevention program (Lancet 1999;353:93-97.). A good fall prevention program may require a home visit from a health care professional such as an occupational therapist.
If you do not have a history of falling, use fall prevention educational materials to help prevent falls. Be sure to review your risk of falling with your doctor every year.
For more information on resources in your community, visit the Center for Healthy Aging and their Falls Free Coalition.
Medical factors contributing to falls:
- cardiovascular or circulatory problem such as symptomatic postural hypotension, arrhythmia, or neurologic dysfunction
- visual impairment
- reduced leg strength
- peripheral neuropathy
- cognitive impairment
Common Fall Hazards in the Home
- Poor access to switches or lamps: Provide ample lighting in rooms and hallways, with switches located at room entrances.
- Low lighting: Provide extra lighting along path from bedroom to bathroom, by one- and two-step elevations, and by top and bottom of stairway landings.
- Lack of night lights: Use nightlights, 100- to 200-watt bulbs, and 3-way light bulbs to increase lighting levels.
- Increased lighting glare: Eliminate glare from exposed light bulbs by using light shades or frosted light bulbs.
Floors and Hallway Problems
- Clutter: Arrange furnishings so that pathways are not obstructed.
- Low-lying objects: Remove low-lying objects.
- Limited walking space: Provide stable furnishings along pathways for balance and support.
- Waxed / wet floors: Provide non-skid rugs and carpet runners on slippery floors; use non-skid floor wax.
- Sliding throw rugs: Replace sliding area rugs with non-skid rugs or place non-skid tape or pads underneath existing rugs.
- Worn carpets: Repair or replace worn carpets.
- Upended / curled carpet edges: Tape down all carpet edges prone to buckling or curling.
- Raised door sills: Remove or place carpeting over threshold to create smooth transition between rooms.
- Low toilet seat: Use elevated toilet seat or install toilet safety frame.
- Inaccessible tub / shower stall: Install wall-mounted or tub-attached grab bar or shower chair / tub transfer bench.
- Slippery floor tiles: Apply non-skid strips / decals to bathroom tiled floors.
- Slippery tub / shower floor: Place non-skid rubber mat on tub floor.
- Lack of handrails: Install well-anchored cylindrical handrails (for hand grasp).
- Slippery steps: Apply non-skid treads to steps.
- Steps in poor repair: Repair worn carpet on steps; apply color-contrasted non-skid tape for visibility.
- Low chair seats: Replace low chairs with those that are easy to get up from and sit down in, add cushion to raise seat height.
- Armless chairs: Provide chairs with armrest support.
- Low / high bed: Replace existing mattress with one that is thinner to lower bed height, or thicker to raise bed height.
- Shelves too low / high: Keep frequently-used objects at waist level.
- Unstable chairs / step stools: Use "reach" device to obtain objects.
- Lack of adequate storage space: Install shelves and cupboards at accessible height.
A number of studies suggest that hip protectors (similar to small football pads) can prevent fractures from falls in a nursing home setting. Cost effectiveness analysis finds that the prescription of hip protectors would be appropriate for patients over age 65 with osteoporosis. Cost savings would be realized for patients who have vertebral fractures or women over age 75 who have osteoporosis and at least one other risk factor for hip fracture.
Despite the benefits from wearing hip protectors, compliance is low in out patient settings and not perfect in nursing homes.