Avoiding FallsOne-third of people over 65 have a fall each year and the risk of falling increases as age rises [1-3]. Falls can seriously impact independence, resulting in ongoing disability, changes in lifestyle, reduced activity and as a result social isolation and death. This is why it’s important to stop the fall before it happens.

Osteoporosis and falls

The impact of falls is compounded in people with osteoporosis, often resulting in multiple appendicular and proximal fractures [4]. Once one fracture has occurred, the chances of having another fracture increases. This 'cascade effect' means women who have suffered a fracture in their spine are over four times more likely to have another fracture within the next year, compared to women who have never had an osteoporotic fracture.

Hip fracture is a serious complication when a person with osteoporosis suffers a fall. The mortality rate increases from 12 per cent to 20 per cent when compared to people of the same age and sex who have not sustained a similar fracture [5].

Among people who survive surgical intervention for an osteoporotic hip fracture, only one-third are restored to their former physical status [6].

Know your risk factors

  • Visual impairment
  • Blackouts and impaired cognition
  • Impaired balance and muscle weakness
  • Kyphosis (also known Dowager's Hump) 
  • Slow walking spped
  • Use of medications that can cause dizziness and drowsiness
  • Multiple drug therapies

Six steps to prevent falls:

  1. Fall-proof your home by removing hazards, installing grab bars and using extra lighting
  2. Do regular, suitable weight-bearing and muscle strengthening exercises, alongside exercises to improve balance
  3. Keep your glasses clean and in good repair, be careful on stairs if wearing bi-focals, and wear sunglasses on bright days to reduce glare
  4. Wear comfortable shoes with good support, a broad heel and non-slip soles
  5. Maintain a healthy diet that includes fresh fruit, vegetables and calcium-rich foods
  6. Talk to your doctor if you feel dizzy, and ask about your medications. Prescription medications can contribute to falling, particularly if you take three or more.

The fall-proofed home

Floors: Remove objects you could trip over, such as throw rugs, electrical cords and clutter. Ensure mats are firmly affixed. Repair loose carpet or raised areas in the floor. Move furniture out of walking paths and be aware of raised doorways.
Bathrooms: Install handrails and non-skid mats in the toilet, bath or shower.
Lighting: Keep your house well lit, especially hallways, stairways, porches and outside walkways. Add extra light switches or use remote switches such as motion sensors.
Kitchen: Use nonskid floor wax, and wipe up spills immediate. Keep regularly used kitchen items at an easy-to-reach level.
Stairs: Check handrails are sturdy and secure.

Hip protectors

Studies have shown external hip protectors markedly decrease hip fractures in people when worn at the time of the event. These shells of propylene or polyethylene are designed to absorb part of the energy from the impact of falling and shunt energy toward the tissue around the hip [7]. However, there is poor compliance among people to wear them because they find them to be uncomfortable and not practical [8].

References

1. Cummings SR, Nevitt MC. Falls. N Engl J Med 1994 ;331 :872-3
2. Royal College of Physicians. Osteoporosis : Clinical guidelines for prevention and treatment. Update on pharmacological interventions and an algorithm for management. London: RCP,2000.
3. National Osteoporosis Society. Primary care strategy for osteoporosis and falls. BathNational Osteoporosis Society, 2002
4. Woolf AD, Akesson K. Preventing fractures in elderly people. BMJ 2003;327:89-95
5. Parker MJ, Palmer CR. Prediction of rehabilitation after hip frature. Age Ageing 1995;24:96-98
6. Greendale GA, Barrett-Connor E, Ingles S, Haile R. Late physical and functional effects of osteoporotic fracture in women: The Rancho Bernardo Study. J Am Geriatr Soc 1995:,43:955-61
7. Kannus P, Pakkari J, Niemi S. Prevention of hip fracture in elderly people with use of a hip protector. N Engl J Med 2000;343:1506-1513
8. Kannus P, Uusi-Rasi K, Palvanen M, Pakkari J. Non pharmacological means to prevent fractures among older adults. Ann Med 2005;37:303-10