Fall Prevention: Awareness and Risk Minimization Are Key
This piece is a contribution by Dr. Eoghan O’Shea, a family physician at The Ottawa Hospital, Civic Campus. He is passionate about fall prevention and works with medical residents in family medicine.All month long, Dr. O’Shea will contribute to the content of Demand a Plan in honour of Fall Prevention Month.
Many people might not consider the occasional fall to come with too many risks,but for seniors, the consequences can be serious. One-third of Canadians over the age of 65 fall every year, and their falls can cause fractures to the hip,pelvis, spine and other fragile bones. Most seniors who suffer a fall-related fracture fall within their own homes, by slipping or stumbling down the stairs or on a level surface such as the kitchen or bathroom floor. Even if no physical injury occurs, many seniors lose confidence after a fall. Post-fall syndrome may include dependence on others for daily activities, loss of autonomy, confusion,immobilization and depression.
Addressing falls with seniors care providers
We must improve our assessment of seniors’ risk of falling. If staying in their own home is of the utmost importance to a senior, we need to take a risk-averse approach, building on their abilities rather than emphasizing their frailties.
A “Staying Independent Checklist” like this one, which is available on paper or electronically from SeniorsBC, is a simple questionnaire that an individual or their caregiver can complete. It consists of 12 questions and explores previous falls, mobility aids, self-reported balance concerns, muscle weakness, urination concerns, side effects from medications, symptoms of anxiety, mood and symptoms of depression. A score of four or higher means an individual is at risk of falling.
The checklist should be used as an assessment tool. It should be reviewed with a senior’s family doctor and other members of their health care team to determine what action should be taken to reduce their risk of falling. This review may happen under the supervision of a geriatrician in a day hospital, in a seniors-friendly clinic or in other community settings. The effectiveness of this tool is determined by the availability of resources, eldercare leaders and individual champions in the community and by whether the patient has significant cognitive concerns.
If a person has a low “Independent” score, preventive measures should be taken, such as the following: two and a half hours of exercise a week, appropriate muscle and bone strengthening exercises to improve balance, annual medication review, alcohol review, smoking cessation counselling and nutritional counselling aided by bone density testing. Care teams may include members of the senior’s primary care team supplemented by a physiotherapist/kinesiologist, occupational therapist,pharmacist and others. The team should explore how frequently the senior has fallen and the circumstances of their falls and should take into consideration any acute or fluctuating medical conditions, chronic medical conditions and cognitive factors.
Taking many medications increases the risk of side effects and drug interactions. Members of the health care team who are evaluating a senior’s risk of falling should look at whether their blood pressure changes when they are in different positions; they should look at the patient’s gait and any balance and mobility problems they may have; and they should also check their vision, feet and footwear.
Fall prevention in the community
A “better strength, better balance” program is essential to increase patients’capabilities and improve outcomes. Resources must shift from assessment to treatment and intervention. Within the community, an ideal fall prevention program is normalized, free and joyous. Some programs can focus on home visits to assess safety modifications, but all should optimize strength, balance,flexibility, agility and bone health and they should include a review of the senior’s medications to see if any can be eliminated. Social activities that address some of these factors include dancing, tai chi, yoga and lawn bowling.
Frailty is preventable and treatable. Just as there is screening for breast cancer, there is screening for fall prevention. Outcomes can be excellent, but care gaps exist in all communities. Much of the impetus for change has come from caregivers and family members; we need caregiver-friendly workplaces and communities. Three-quarters of caregivers work outside the home; they require help with navigating the health care system, missing time from work and anticipating future problems that may arise, as well as financial and emotional support. Various provinces have caregiver and patient groups, like Fall Prevention Community of Practice, the Ontario Neurotrauma Foundation and March of Dimes, which support patients with conditions that increase fall risk, such as Parkinson’s, osteoporosis and Alzheimer’s.Identifying champions in your region is essential.
Fall prevention programming that aligns with Demand a Plan would see national caregiving support organizations working with the Canadian Medical Association and others to change policy at the federal, provincial/territorial and municipal levels. Caregivers need access to better education and development opportunities, and they need to receive meaningful financial and emotional support. It should be easier for people to access programs and information. To achieve this, we need to make it easier for people to navigate the health care system and we need to eliminate silos. Patients, health care providers and caregivers should be able to access the information most pertinent to them, with special consideration and support for vulnerable populations like First Nations communities and those in rural and impoverished settings.
This piece was written by Dr. Eoghan O’Shea as part of the Experts in the Field series. Experts in the Field allows guest contributors to write about seniors care from their point of view and share their plan for a better tomorrow. The Canadian Medical Association would like to thank Dr. O’Shea for his contribution.