Falls are one of the major causes of injury amongst older people and stand as the second leading cause of death worldwide.

Did you know

Falls are a major health issue in the community, with around 30% of adults over 65 experiencing at least one fall per year

Falls account for 40% of injury-related deaths and one percent of total
deaths in the over 85ʼs

Between 22-60% of older people suffer injuries from falls
10-15% suffer serious injuries
2-6% suffer fractures
0.2-1.5% suffer hip fractures

Definition of a Fall

A fall is when a person unintentionally goes from a higher to a lower point, or from a standing position onto a chair. It doesn’t include intentional changes in position such as intentionally sitting on a chair or if the person collapses from a medical episode such as a stroke.
The impact of falls can be very serious
● Physical injuries such as bruises, skin tears, fractures, and head trauma
● Can often lead to hospitalization, surgery, and even death
● Psychological strain and loss of confidence to maintain quality of life

• Altered medical conditions such as – Incontinence – Parkinson’s disease – Dementia – UTIs • Malnutrition • The type and number of medications used • Psychosocial changes such as anxiety and depression • Problems with sensory-motor functions such as balance, muscle weakness, vision and hearing impairment. • Environmental factors such as unsafe footwear, poor lighting, cluttered rooms etc

Hearing • Not wearing hearing aids • Wax buildup or ear infections affecting their balance Vision • Bifocal glasses • Wearing the wrong glasses Inactivity • Leading to muscle wasting and impaired balance. Walking aids • Incorrect walking aids • Inappropriately fitted walking aids

Medication associated with increased risk of falls

Some medications or combinations of medications may increase the risk of falling. Certain classes of medication as well as the overall number of medicines prescribed simultaneously have shown a similar effect on fall risk.

How Medications Increase Risk of Falls :

• Antihypertensives, by reducing blood pressure and/or slowing the heart rate • Sedatives, antipsychotics, and anticonvulsants act on the brain causing increased sedation and gait disturbance. • Antidepressants, particularly sedating antidepressants can cause drowsiness and slow reaction times • Cardiovascular medications can exacerbate dizziness or light-headedness from their effect on BP. • Anticholinergic agents affect vision making it blurry and causing double vision • Diuretics such as Frusemide and Hydrochlorothiazide have a diuretic effect, making people rush to urinate more frequently

Some medications may also impact the severity of falls e.g. if someone is on anticoagulants, they are at greater risk of bleeding. Regular medication reviews are important to assess the number, time, and dosage of medications that can be reduced

Postural/Orthostatic Hypotension

Determining Medication Falls Risk

The Agency for Healthcare Research and Quality developed the medication fall risk score to evaluate patients’ fall risk related to the use of certain high-risk medications. Each medication included in the tool is given a score from 1 to3 based on its contribution to fall risk. A combined score of more than 6 points means that a person is considered to be at higher risk of falls and may signal the need for an in-depth evaluation by the prescriber and pharmacist to further evaluate the person’s medication regimen. How do your residents score?

Hydration & Nutrition

It is important to support people to maintain a well-balanced diet, to ensure they get the necessary hydration and nutrition. A low body weight due to malnutrition can increase falls risk, due to the effects on strength and bone density. Vitamin D is a vitamin that helps improve muscle function, and in conjunction with calcium helps minimize bone loss. Evidence-based research suggests that if older people take Calcium and Vitamin D supplements, it can lead to a reduced risk of falls and reduced fracture rates. At least three serves of calcium-rich foods are recommended each day. Although Vitamin D is found in some food sources (eggs, margarine, oily fish), the best source is the sun.

Other important vitamins associated with mobility include Vitamins A, C and E. All are important for eye health and a deficiency can cause vision impairment that can lead to confusion, disorientation and poor balance, increasing the risk of a fall. Folic Acid and Vitamin B12 deficiency can also cause confusion and affect perception or awareness of the position and movement of the body, again affecting mobility

Strategies to Minimize the risk of Falls

• Encourage and enable residents to stay as active as possible. • Review BP and BGL levels if possible • Assess their medication use and refer for RMMR • Remove any clutter from their room and other common areas around the home • Assess walking aids and footwear • Keep a night light for bathroom use, • For residents with cognitive decline – Allow assisted toileting rounds after administering medications such as Frusemide. Apply Hip protectors, making sure they are worn correctly