Stay Safe With These Fall-prevention Guidelines
The American Geriatrics Society and the British Geriatric Society have issued updated guidelines for preventing falls.
The American Geriatrics Society and the British Geriatric Society have issued updated guidelines for preventing falls in older people. It is the first such update in over 10 years.
“There is always evidence that is coming out and in area like falling, we are learning more about it every day,” says Mary Tinetti, MD, a professor of medicine at Yale University School of Medicine, New Have, Ct., and a co-chair of the panel that came up with the guidelines. “We want to make sure the guidelines are as timely and accurate as possible.”
While the guidelines, which appear in the January 2011 issue of the Journal of the American Geriatrics Society, target older patients, they apply to patients of any age with rheumatic disease involving gait.
“It relates to all of our patients who have lower extremity disorders,” says Nortin M. Hadler, MD, attending rheumatologist at UNC Hospitals and professor of medicine and microbiology/immunology at University of North Carolina at Chapel Hill.
“Gait is quite remarkable. It’s a highly integrated biological function that requires heel strike and push off of toes, knees that are supple and hips with reasonable range of motion,” says Dr. Hadler. “All of these things we take for granted, but if anyone has any impairment, they don’t take it for granted.” Dr. Hadler notes that patients with rheumatic disease also fall “less well” because they are less able to brace themselves when they do fall.
The new guidelines call for a complete risk assessment for patients who simply report difficulties with gait or balance in addition to those who have a history of falling. The assessment should include evaluation for muscle weakness, balance problems, orthostatic hypotension (a fall in blood pressure when a person stands up from a sitting or lying down position), as well as an examination of the feet and footwear, and an evaluation of both daily living skills and the use of adaptive equipment and mobility aids. Health care professionals should also ask patients about the fear of falling.
“Falls are a very serious problem and they often have a complex set of causes that can be a challenge to sort out. One of those things is that we are fearful,” says Sharon Brangman, MD, president of the American Geriatric Society. “Patients can be so fearful that it limits mobility, which sets up a vicious cycle: We are fearful, so we restrict our activities, and our muscles get weaker and so we are more likely to fall.”
The guidelines were developed by a panel including members from previous panels, as well as experts in areas such as geriatrics, physical therapy, orthopedics, emergency medicine, occupational therapy, nursing and pharmacy. To come up with the new guidelines panelists reviewed the medical literature on fall prevention published between May 2001 and July 2009.
“The main thing is that these guidelines were developed by a panel of experts who scoured the literature and scientific information to find guidelines based in science,” says Dr. Brangman. “We knew things anecdotally, but these guidelines have evidence behind them.”
Within the new guidelines are recommendations for intervention that include:
- an exercise component that combines balance and strength training, such as tai chi or physical therapy.
- cataract surgery when needed (but only in conjunction with other interventions).
- medication reduction or withdrawal, especially drugs that affect the central nervous system, such as sleep medications and antidepressants.
- appropriate management of heart rate and rhythm abnormalities, and orthostatic hypotension.
- a daily 800 IU vitamin D supplement.
“The new guidelines are not all doctor-oriented,” says Dr. Brangman. “They have practical pieces that people can carry out on own: finding safer shoes, removing clutter in your home, clearing off stairs and installing handrails in bathrooms and on steps.”
But the interventions must be followed. “It really made a difference in how carefully all the interventions were carried out,” says Dr. Tinetti. “It’s important not just to say that something needed to be done, but to do it.”