Elderly patients pose special challenges when it comes to falls, so your prevention strategy must take into account the factors unique to this population. This summary is offered by Roberta A. Newton, PhD, professor of physical therapy at Temple University in Philadelphia:
• Vision: Visual acuity decreases with age. Therefore, periodic eye exams or checkups are recommended. Be aware that either old prescriptions or new prescriptions can alter the visual field and cause falls. Also, clean glasses daily.
Changes in contrast sensitivity occur. This is related to the ability to detect and discriminate objects in the environment. One way to accommodate this is to increase the lighting, such as using higher wattage bulbs.
Decline in depth perception occurs as a decreased ability to judge distances and relationships among objects in the visual field. Stairs, carpets with patterns, and curbs are risk factors for individuals with such declines in depth perception. The person may have difficulty estimating the height of the step and therefore misplace the foot. Or the person may think that the carpet is uneven and alter balance and walking to accommodate the misperception.
The ability to recover from a sudden exposure to a bright light or glare decreases. When moving from a dimly lit to a brightly lit environment or the reverse, the person should pause a second to allow the eyes to accommodate to the change in light.
• Hearing: Periodic hearing checkups are recommended. Because we rely on sound for orientation in the environment, a person may not be as quickly aware of a potentially hazardous situation when hearing is decreased.
• Feet and shoes: More than 75% of older adults have foot pain. Foot pain is caused by, but not limited to, thin heel pads, corns, bunions, dry and cracked skin, ingrown or overgrown toenails, and sores. Foot pain can cause a change in the biomechanics or alignment of the body, thereby increasing the risk for falls.
Another potential risk factor for falls is decreased sensation in the feet. This is more noticeable in the person with diabetes, but gradually occurs with the aging process. Sensation can be tested on the person using a Q-tip or something soft and brushing it on the sole of the foot. Caregivers also may consider a daily foot inspection for red areas, sores, condition of toenails; application of cream; avoidance of abrasive substances such as pumice stone or acid to reduce calluses or corns; and, shoe inspection for worn areas.
Also noteworthy is the condition of the person’s currently worn shoes and slippers. Ill-fitting or badly worn footwear can lead to tripping and falling or sprains and strains. This problem is especially hazardous when combined with ill-fitting clothing that drags on the floor.
• Medications: Four or more medications constitute an automatic risk factor for falls. Single or multiple medications (polypharmacy) can cause side effects such as dizziness, drowsiness, or low blood pressure. Prescription medicines and regularly taken over-the-counter medications should be checked by the physician or pharmacist.
• Balance and gait: A gradual decline in balance abilities and speed of gait occurs with age. These two are linked with activity level. One cause of tripping and stumbling is the anterior tibialis muscle, which dorsiflexes the ankle and toes to clear the toes during walking. With age, it becomes a little out of sync in its timing with other muscles in the leg. As a result, the timing of toe clearance is a little off and the toe may catch on the floor. During walking, toe clearance is approximately 1 cm.
Gait speed also decreases, and the person may not have sufficient time to get out of the way or may have to hurry to perform various activities. To have to walk faster, particularly when it is associated with anxiety, can cause a fall.
Remaining active and participating in leisure and social activities helps maintain balance and gait.
• Blood pressure: Both high and low blood pressure can cause a person to become unsteady. When moving from one position to another, such as either from the bed to sitting or from a chair to standing, the person should pause for a couple of moments to let the blood pressure adjust and to orient to the new position.
(For more advice on preventing falls among the elderly, see www.temple.edu/older_adult/fppmanual.html.)