Older adults

  Population considerations

  • Environmental hazards. Slippery floor surfaces, loose rugs, low furniture, lack of handrails, uneven pavement, loose stones and pathway obstructions lead to an increased risk for injury from falls. (Ulione, 1997)
  • Existing medical conditions.  Certain medical conditions such as stroke and visual problems make older adults more susceptible to falls (Ulione, 1997). 
  • Use of certain medications. Some medications can cause balance problems for older adults, increasing their risk of falls (Ulione, 1997, York, 2006). 
  • Hazardous weather.  Slipping on ice or snow during winter causes a substantial number of falls in older adults, especially elderly women (Bjornstig, 1997).
  • Use of wheelchairs.  Older adults suffer injuries after falling from wheelchairs due to uneven terrain, attempting to reach for something, transferring out of the chair or trying to maneuver curbs or stairs (Gavin-Dreschnack, 2005). 
  • Lack of physical activity.  Physical activity plays a large role in preventing falls in older adults, yet many barriers to physical activity may exist for older adults (York, 2006).  See Physical Activity Populations, Older Adults

  Strategies to address these considerations

  • Improve environment. Removing items that could potentially cause falls and installing safety devices such as handrails in bathrooms, in stairways and on ramps can lessen the risk of injury from falls (DHSS, 2006, Ulione, 1997).  Use adequate lighting to ensure proper vision in living, walking and working areas (DHSS, 2006). Easy-to-open doors, widened doorways, kitchen modifications and railings can help to prevent wheelchair falls (Gavin-Dreschnack, 2005). 
  • Involve community stakeholders. It may be useful to work with individuals living alone and management and staff in assisted living and nursing facilities, as well as community organizations, local businesses and governmental leaders to create changes in environments to decrease the risk of injury (York, 2006).
  • Increase knowledge. Community leaders and policymakers can carry out community-based education interventions focused on fall prevention strategies and the risk for hip fracture (DHSS, 2006).  Educational programs should include information about wellness activities, fitness, nutrition, home environment hazards, clinical assessments of risks for falling and hip fractures and referrals for follow-up (DHSS, 2006).
  • Improve communication. Health care providers should improve communication with patients concerning the risk of falling associated with medical conditions and medications. Nursing staff educated about the difficulties associated with avoiding falls can improve the health of nursing home residents (Ulione, 1997). 
  • Identify those at risk.  Simple clinical screening tests can accurately identify older adults who are more likely to fall (DHSS, 2006).
  • Use assistive devices.  A variety of assistive devices are available for use to prevent or lessen injury from falls in older adults: hip protectors, walkers, wrist protectors and restraints (Bjornstig, 1997, York, 2006). 
  • Monitor medications. Working with the adult’s health care providers and pharmacist to review medicines (particularly sedatives and anti-depressants) can help to manage and prevent falls (DHSS, 2006, York, 2006).   
  • Use appropriate footwear.  Helping older adults find appropriate footwear can prevent injuries from falls (York, 2006). The best shoes include slip resistant outer soles along with midsole thickness and density for maximum stability (York, 2006).  Slipping protection should be placed on the back of the heel, not under the front part of the shoe (Bjornstig, 1997). 
  • Address hazardous weather conditions. More effective clearing of the snow from sidewalks and spreading of sand and salt immediately after a snow fall or ice formation can reduce injuries in the winter (Bjornstig, 1997).  Popular locations for elderly people such as business areas, bus stops and medical centers should take priority when clearing snow and spreading sand and salt (Bjornstig, 1997).  Better slip preventive aids on shoes can reduce slips and falls (Bjornstig, 1997). Organizing assistance with shopping, snow clearing and sanding for older adults, as well as organizing a transport service for them would decrease slipping opportunities (Bjornstig, 1997).
  • Maintain wheelchairs. Keeping wheelchairs in good condition and working order, as well as developing educational campaigns for older adults to stress proper chair behavior, can prevent falls (Gavin-Dreschnack, 2005).  Locks, laptop safety cushions, wheelchair monitors, anti-tipping devices and frame modifications are devices available to maintain safety while using a wheelchair. Proper wheelchair prescription and training can reduce injuries to wheelchair users and caregivers (Gavin-Dreschnack, 2005).
  • Increase physical activity.  Exercise can greatly reduce falls by increasing strength, endurance and flexibility (York, 2006). See Physical Activity Populations, Older Adults
  • Incorporate vision checks. Older adults should have their vision checked regularly to protect eyesight and balance (York, 2006).

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