This winter, lend a hand to break seniors' falls

By Jennifer Laliberté

Canada's seniors are standing on shaky ground. Every year, one out of every three of them will take a nasty tumble — and many of them never fully recover. Winter is a particularly treacherous time, and thanks to the ice caused by this season's yo-yo weather, temperature records won't be the only things being broken on our city streets this year.

Falls are the nation's top cause of accidental death in people over 65 and they account for more than half of all injuries and a quarter of all hospitalizations. And what's worse — the overwhelming majority of these spills are preventable. "Effective fall prevention strategies do exist," asserts Dr Glen Ginther, a gerontologist and medical director of the Falls Prevention clinic at the QEII hospital in Halifax, "and I think the fact that there are so many services attest to that."

You might be pleasantly surprised to learn just how many specialized clinics and prevention programs are available across the country. So take advantage of this wealth of access to help your patients keep their feet on terra firma.

AN OUNCE OF PREVENTION
Nearly half of all falls occur at home, so the first thing you'll want to tell patients is to make sure they take all the necessary steps to make their house as safe as possible. You'd be surprised how much of a difference a few simple changes can make (hand your patients a copy of our "Guide to a fall-safe home," right).

Dr Ginther says that while environmental factors like slippery sidewalks and unlit stairwells certainly contribute to falls, there are personal characteristics that put patients at risk as well. "This is something we spend a lot of time on in our program," he says. "We assess each patient's risk of falling, and put in whatever preventive strategies are needed accordingly."

Assess risk Look for signs of muscle weakness, balance or motility first and foremost, Dr Ginther says. Poor eyesight can also make it hard for seniors to stay sure-footed, so stress how important it is that they have their vision checked once a year. Arthritis, particularly of the large joints like the hip, knee or ankle, is also a risk factor for falls and, of course, a senior's feet deserve a little extra attention. "Examine feet to see if they have painful corns or calluses and make sure they're wearing appropriate footwear," suggests Dr Ginther. "Some older people can have loss of sensation in their feet due to neuropathy, which can make a fall much more likely," he adds.

There are a number of medical conditions — like dementia, Parkinson's disease or a prior stroke — that can increase the risk of falling, and in such cases effective treatment is often not available. So, you'll want to be fully informed of the gravity of a patient's medical condition so that you can size up any potential risk and counter it with targeted preventive strategies.

What are they on? It's always a good idea to review an elderly patient's medicines periodically — and a thorough fall risk assessment is the perfect excuse to do it. "The main worrisome [medications] are any that act on a person's brain — sedatives in particular," says Dr Ginther. Antipsychotics and antidepressants can also interfere with patients' physical stability, so find out if there's a current, valid reason for them to be taking each of the drugs they're on. "If not, encourage them to discontinue," says Dr Ginther. If the drug is still truly appropriate, make sure they're taking the lowest dose possible to minimize side effects and interactions.

Get movin' One of the most important and proactive steps seniors can take to prevent falls is to remain as active and physically fit as possible. Be sure to tell your patients they can reduce their risk of serious injury dramatically by exercising regularly. "It's important for patients to understand that they don't have to jog or run for miles to decrease their risk of falling" says Dr Ginther. Things like Tai Chi, which improve strength and balance, are especially appropriate exercises.

Fear factor "Once an elderly person has a fall, they become frightened of falling again," says Dr Ginther. As a result, they tend to limit their movements, which not only reduces their quality of life, but also drains much of their strength, flexibility and mobility. If a patient has already fallen, or is at high risk of doing so, be sure to tell them about the various helper devices (see below) that can increase their confidence and help ensure their continued independence.