“No two falls are the same,” according to a Harvard Medical School article by Brad Manor, PhD. “Each fall occurs from the unique interaction of the person’s balance, the task they were performing just prior to the fall, and the ever-changing environment in which they were moving. All these things make it difficult to pinpoint the exact cause of a particular fall, and nearly impossible to uncover commonalities across all falls suffered by older adults.” With falls among older adults rising, and the issue difficult to study, medically directed home care is positioned to play a significant role in helping older adults at risk.

Fall Prevention Programs: Hanging in the balance?

The question: Can more falls be prevented if the right measures are taken? The evidence is mixed.

A 2014 randomized control trial (RCT) made it clear, in a study of 1300+ home-dwelling adults age 70+, that a 12-month program involving strength/balance training, medical review, medication management, nutrition, and home hazard assessment reduced the rate of falls by almost 30%.

An Australian research project (2019) of adults age 65+ found a 47% reduced likelihood of falling among those engaged in fall-prevention measures. But a more recent study , determined that fall prevention program participation “did not result in a significantly lower rate of a serious fall injury” for participants age 70+.

So, while research continues to explore the degree to which fall prevention can be effective, healthcare providers, older patients, and their caregivers continue to seek ways to reduce fall-related risks.

The overlap of anxiety and depression is 45%

“An older adult is treated in the emergency room for a fall every 11 seconds.”

The 2019 Harvard Health Publishing article quoted above indicates the sheer volume of fall-related health crises – and the need to avoid the ones that can be avoided.

5 Steps Toward Fewer Falls

The sheer volume of people affected by falls has resulted in an abundance of thought on the best way to avoid them. Here is a summary of findings.

  1. EXERCISE. Some of the most convincing evidence of the effectiveness of exercise in fall prevention showed a 23% reduction in falls among older adults who exercise regularly.
  2. Lights and rails. “Vision changes with aging and less light reaches the retina,” said SeniorBridge clinical practice lead Debora Hess. “That makes it harder to see contrasting edges, tripping hazards, and obstacles.” Table lamps, automatic night lights, and wall-switch operated overhead lights are three examples of how to keep older people on their feet by simply enabling them to see their surroundings. Hand rails – in staircases, bathrooms, and anywhere stability is jeopardized – are also essential. If these actions seem obvious, consider that home safety evaluations are commonly overlooked.
  3. Medication monitoring and management. Today’s Geriatric Medicine reported in their 2017 article on “Medications that increase fall risk” the key classifications of drugs involved in falls. The total number of variations is in the hundreds.
    • Psychotropic drugs (including antidepressants)
    • Cardiovascular drugs (including blood pressure meds)
    • Pain Medications (specifically opioids)
    • Anticonvulsants

Amount of older adults who are prescribed drugs that raise the risk of falling

The overlap of anxiety and depression is 45%

A longitudinal Science Daily study from 1999-2007 details the rise in prescriptions that elevate the risk of a fall. “Nearly every older adult was prescribed a prescription drug that increased their risk of falling in 2017,“ the University at Buffalo study reported, noting that it is “a significant leap from 57% in 1999.”

  1. Tai Chi. The National Council on Aging, which uses evidence-based measures to analyze fall prevention techniques, reminds us that the slow, controlled, mindful movements of Tai Chi have yielded a 55% reduction in falls, underscoring its value as part of movement-based fall prevention.
  2. Make it a routine. Older patients are sometimes hard to mobilize and hard to motivate. Yet research published in 2018 suggests that engaging older adults in discussion and practice around fall prevention is critical.

It’s important to add that each of the 5 actions described above must be incorporated in an older person’s daily life; practice and consistency take time and discipline to take effect. And this is part of what medically directed home care can do on a daily basis.

“Lots of medications can elevate the risk of a fall. It might be drowsiness or an altered mental state, like agitation. Even the side effect of frequent urination, which requires a person to get up and navigate their way to and from the bathroom in the night, can increase the chances of a fall.”

Christina Hahn, RN, MSN, and SeniorBridge Supervisor of Care Managers

The integrated care management model by SeniorBridge

Home care services vary widely in the services they provide.

SeniorBridge offers an integrated care management practice model that involves two components:

  1. Clinical care (under the direction of an RNCM/Registered Nurse Care Manager) supported by a Social Worker and a team of caregivers, based on patient’s needs and
  2. A portfolio of home care services and geriatric care management in such areas as nutrition, caregiver education, benefit coordination, transportation, and coordination with discharge planners, physicians, pharmacy, home health agencies, and care managers.

NOTE: We have full COVID-19 safety protocols in place to keep clients, families and associates safe.

For more information on medically directed home care, contact SeniorBridge.

Sources consulted:
National Library of Medicine/National Center for Biotechnology Information (2014)
National Library of Medicine/NIH (2018)
National Library of Medicine/NIH New England Journal of Medicine (2020)
Cochrane Library (2019)
National Library of Medicine/NIH (2016)
Today’s Geriatric Medicine.com
Science Daily (2021)
National Council on Aging (2021)
BMC/Springer Nature (2018)

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